Healthcare Provider Details

I. General information

NPI: 1104474295
Provider Name (Legal Business Name): COLTON CHARLES HANKINS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2019
Last Update Date: 08/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26525 NE ALLEN CT APT 1
DUVALL WA
98019-5026
US

IV. Provider business mailing address

PO BOX 160
DUVALL WA
98019-0160
US

V. Phone/Fax

Practice location:
  • Phone: 509-860-0948
  • Fax:
Mailing address:
  • Phone: 509-860-0948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60629361
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: