Healthcare Provider Details

I. General information

NPI: 1215588504
Provider Name (Legal Business Name): STEPHANIE R HARRIS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18421 HIGHWAY 99 STE G
LYNNWOOD WA
98037-4457
US

IV. Provider business mailing address

115 124TH ST SE APT B3
EVERETT WA
98208-5708
US

V. Phone/Fax

Practice location:
  • Phone: 425-582-9951
  • Fax:
Mailing address:
  • Phone: 206-321-7299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60823987
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: