Healthcare Provider Details

I. General information

NPI: 1528359957
Provider Name (Legal Business Name): KARLA DENISE BORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 N DIVISION ST
SPOKANE WA
99202-1899
US

IV. Provider business mailing address

4217 N CRESTLINE ST
SPOKANE WA
99207-4353
US

V. Phone/Fax

Practice location:
  • Phone: 509-487-4503
  • Fax:
Mailing address:
  • Phone: 509-778-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00025059
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: