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General NPI Number Information
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NPI Number | 1295446524
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Entity Type | Individual
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Provider Name | CELINA CLARK LMT
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Gender | Female
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Dates
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Enumeration Date | 12/07/2022
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 200 1ST ST S
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City | MONTESANO
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State | WA
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Zip | 98563-3041
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Country | US
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Telephone | 360-310-8028
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Fax |
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Provider Business Mailing Address
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Address Line | 18 MENZO HAVERLY RD
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City | ELMA
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State | WA
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Zip | 98541-9697
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Country | US
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Telephone | 253-797-7830
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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 |
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License Number State | WA
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