Healthcare Provider Details

I. General information

NPI: 1417289224
Provider Name (Legal Business Name): CONNIE MARIE HOOPER LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E. SUNSET WAY
ISSAQUAH WA
98027
US

IV. Provider business mailing address

435 E. SUNSET WAY
ISSAQUAH WA
98027
US

V. Phone/Fax

Practice location:
  • Phone: 425-392-4792
  • Fax: 425-837-0311
Mailing address:
  • Phone: 425-392-4792
  • Fax: 425-837-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60109442
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: