Healthcare Provider Details

I. General information

NPI: 1225576952
Provider Name (Legal Business Name): NOVA GRIFFIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10117 MAIN ST
BOTHELL WA
98011-3425
US

IV. Provider business mailing address

12233 NE 169TH ST
BOTHELL WA
98011-7126
US

V. Phone/Fax

Practice location:
  • Phone: 425-750-4420
  • Fax:
Mailing address:
  • Phone: 425-750-4420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60724971
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: