Healthcare Provider Details

I. General information

NPI: 1881413458
Provider Name (Legal Business Name): SAMANTHA JO M ARAUCTO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11014 SE 192ND ST
RENTON WA
98055-7432
US

IV. Provider business mailing address

25812 179TH PL SE
COVINGTON WA
98042-5827
US

V. Phone/Fax

Practice location:
  • Phone: 253-859-6441
  • Fax: 253-859-9437
Mailing address:
  • Phone: 253-859-6441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61583290
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: