Healthcare Provider Details

I. General information

NPI: 1851855753
Provider Name (Legal Business Name): KENYARI BJERKE MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 TALBOT RD S STE 304
RENTON WA
98055-6238
US

IV. Provider business mailing address

635 S 32ND ST
RENTON WA
98055-5099
US

V. Phone/Fax

Practice location:
  • Phone: 425-264-5060
  • Fax: 877-204-0172
Mailing address:
  • Phone: 612-423-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60899124
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: