=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417833468
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NY'YANA RYANN PICKLE LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2025
-----------------------------------------------------
Last Update Date | 08/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33400 13TH PL S
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003-6357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-838-6070
-----------------------------------------------------
Fax | 253-838-6069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12520 SE 273RD PL
-----------------------------------------------------
City | KENT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98030-8504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-327-4484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA70005904
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------