Healthcare Provider Details

I. General information

NPI: 1003321852
Provider Name (Legal Business Name): JONATHON DUSTIN KOCHER MASSAGE THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4150
US

IV. Provider business mailing address

1002 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4150
US

V. Phone/Fax

Practice location:
  • Phone: 253-750-3381
  • Fax: 253-267-1860
Mailing address:
  • Phone: 253-750-3381
  • Fax: 253-267-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60806961
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: