Healthcare Provider Details

I. General information

NPI: 1619308145
Provider Name (Legal Business Name): RACHEL ROSE MOSER MASSAGE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2013
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14090 FRYLANDS BLVD SUITE 274
MONROE WA
98727
US

IV. Provider business mailing address

18920 BOTHELL WAY NE SUITE 100
BOTHELL WA
98011-1981
US

V. Phone/Fax

Practice location:
  • Phone: 360-805-0112
  • Fax: 425-487-6818
Mailing address:
  • Phone: 425-486-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 00019527
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: