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General NPI Number Information
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NPI Number | 1699666123
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Entity Type | Individual
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Provider Name | JOLYNN MARIE PETERSON LMT
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Gender |
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Dates
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Enumeration Date | 07/12/2025
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Last Update Date | 07/12/2025
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Provider Practice Location Address
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Address Line | 3712 9TH ST SW STE 1A
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City | PUYALLUP
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State | WA
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Zip | 98373-3564
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Country | US
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Telephone | 253-414-2964
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Fax | 253-880-1082
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Provider Business Mailing Address
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Address Line | 3712 9TH ST SW STE 1A
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City | PUYALLUP
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State | WA
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Zip | 98373-3564
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Country | US
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Telephone | 253-414-2964
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Fax | 253-880-1082
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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 | MA61558874
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License Number State | WA
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