Healthcare Provider Details

I. General information

NPI: 1548382716
Provider Name (Legal Business Name): JOY RENE COBLE LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33009 NE 78TH ST
CARNATION WA
98014-6703
US

IV. Provider business mailing address

33009 NE 78TH ST
CARNATION WA
98014-6703
US

V. Phone/Fax

Practice location:
  • Phone: 425-333-5775
  • Fax: 425-333-5775
Mailing address:
  • Phone: 425-333-5775
  • Fax: 425-333-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017377
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: