Healthcare Provider Details

I. General information

NPI: 1902921612
Provider Name (Legal Business Name): ROANN TAYLOR LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9212 EVERGREEN WAY
EVERETT WA
98204-7125
US

IV. Provider business mailing address

PO BOX 194
GRANITE FALLS WA
98252-0194
US

V. Phone/Fax

Practice location:
  • Phone: 425-231-7820
  • Fax: 425-267-0961
Mailing address:
  • Phone: 425-231-7820
  • Fax: 425-267-0961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00020852
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: