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General NPI Number Information
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NPI Number | 1063616704
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Entity Type | Individual
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Provider Name | ANNELIESE CHRISTA ROSE LMP
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Gender | Female
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 SW 39TH ST STE 150 HEALTH CARE MANAGEMENT
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City | RENTON
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State | WA
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Zip | 98055-4915
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Country | US
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Telephone | 253-264-2950
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Fax | 253-264-2591
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Provider Business Mailing Address
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Address Line | 6417 REBECCA CT SE
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City | AUBURN
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State | WA
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Zip | 98092-8020
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Country | US
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Telephone | 253-632-6417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 20841
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License Number State | WA
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