MEDICARE: GABRIELLE DJOY KILAYKO GOMEZ LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA61596068	WA

General Provider Information

NPI Number	:	1174346068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE DJOY KILAYKO GOMEZ LMT

Provider Business Mailing Address
First Line	:	4502 S WARNER ST UNIT C
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98409-5509
Country	:	US
Telephone Number	:	719-306-7411
Fax Number	:

Provider Business Practice Location Address
First Line	:	3624 6TH AVE STE C
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98406-5400
Country	:	US
Telephone Number	:	719-306-7411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	11/07/2024

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