Healthcare Provider Details

I. General information

NPI: 1992203178
Provider Name (Legal Business Name): RACHEL HUDSON LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MARKET ST NE STE 108
OLYMPIA WA
98501-1008
US

IV. Provider business mailing address

4220 132ND ST SE STE 101
MILL CREEK WA
98012-8999
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-7085
  • Fax:
Mailing address:
  • Phone: 425-316-8046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60813324
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: