Healthcare Provider Details

I. General information

NPI: 1639307309
Provider Name (Legal Business Name): DAWN RENEE KUZARO L.M.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14410 SE PETROVITSKY RD SUITE109
RENTON WA
98058-8900
US

IV. Provider business mailing address

718 GRIFFIN AVE # 305
ENUMCLAW WA
98022-3418
US

V. Phone/Fax

Practice location:
  • Phone: 425-226-0327
  • Fax:
Mailing address:
  • Phone: 253-709-7967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA13756
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: