Healthcare Provider Details

I. General information

NPI: 1134579097
Provider Name (Legal Business Name): RACHEL LEAH VAHLBERG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15965 NE 85TH ST SUITE 102
REDMOND WA
98052-3593
US

IV. Provider business mailing address

15001 35TH AVE W #6-202
LYNNWOOD WA
98087-2343
US

V. Phone/Fax

Practice location:
  • Phone: 425-882-9065
  • Fax: 425-558-1900
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60553316
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: