Healthcare Provider Details

I. General information

NPI: 1083588107
Provider Name (Legal Business Name): RHIANNA LYNNAE STOCKDALE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S RACE ST STE C
PORT ANGELES WA
98362-6400
US

IV. Provider business mailing address

601 S RACE ST STE C
PORT ANGELES WA
98362-6400
US

V. Phone/Fax

Practice location:
  • Phone: 360-462-7636
  • Fax: 360-457-4221
Mailing address:
  • Phone: 360-462-7636
  • Fax: 360-457-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.61690352
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: