Healthcare Provider Details

I. General information

NPI: 1255500922
Provider Name (Legal Business Name): JOANIE RAE PHELPS L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 COLE ST STE 6
ENUMCLAW WA
98022
US

IV. Provider business mailing address

P.O BOX 1406
ENUMCLAW WA
98022
US

V. Phone/Fax

Practice location:
  • Phone: 425-531-4894
  • Fax: 425-433-0733
Mailing address:
  • Phone: 425-531-4894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00018315
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: