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General NPI Number Information
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NPI Number | 1164218764
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Entity Type | Individual
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Provider Name | IRINA STEFANOVA MA61677022
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Gender | Female
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 1700 S 305TH PL STE A
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City | FEDERAL WAY
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State | WA
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Zip | 98003-4804
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Country | US
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Telephone | 253-941-8275
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Fax |
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Provider Business Mailing Address
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Address Line | 1675 S 52ND ST
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City | TACOMA
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State | WA
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Zip | 98408-1436
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Country | US
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Telephone | 253-290-6030
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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 | MA61677022
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License Number State | WA
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