Healthcare Provider Details

I. General information

NPI: 1255814257
Provider Name (Legal Business Name): CONNIE ZUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N 98TH ST APT 33
SEATTLE WA
98103-3255
US

IV. Provider business mailing address

929 N 98TH ST APT 33
SEATTLE WA
98103-3255
US

V. Phone/Fax

Practice location:
  • Phone: 509-599-1122
  • Fax:
Mailing address:
  • Phone: 509-599-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: