Healthcare Provider Details

I. General information

NPI: 1417185968
Provider Name (Legal Business Name): BEATA VIXIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 NE HICKMAN CT SUITE 1
PULLMAN WA
99163-5617
US

IV. Provider business mailing address

1230 NE HICKMAN CT SUITE 1
PULLMAN WA
99163-5617
US

V. Phone/Fax

Practice location:
  • Phone: 509-432-5053
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60100417
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: