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General NPI Number Information
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NPI Number | 1457619744
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Entity Type | Individual
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Provider Name | AGATHAREZA N. CHUA LMP
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Gender | Female
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 2310 MILDRED ST W STE 130
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-6055
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Country | US
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Telephone | 253-460-4244
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Fax |
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Provider Business Mailing Address
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Address Line | 5406 54TH AVENUE CT W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98467-4819
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Country | US
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Telephone | 808-779-6123
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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 | MA60281707
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License Number State | WA
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