Healthcare Provider Details

I. General information

NPI: 1467086363
Provider Name (Legal Business Name): MRS. VERONIKA REPOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SW BARTON ST STE A24
SEATTLE WA
98126-3993
US

IV. Provider business mailing address

2600 SW BARTON ST STE A24
SEATTLE WA
98126-3993
US

V. Phone/Fax

Practice location:
  • Phone: 206-453-5397
  • Fax:
Mailing address:
  • Phone: 206-453-5397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61033114
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: