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General NPI Number Information
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NPI Number | 1730472440
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Entity Type | Individual
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Provider Name | BETHANY CONCEPCION VALENCIA LMP
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Gender | Female
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Dates
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Enumeration Date | 05/27/2011
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 136 102ND AVE SE STE 104
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City | BELLEVUE
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State | WA
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Zip | 98004-8135
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Country | US
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Telephone | 425-455-0669
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Fax |
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Provider Business Mailing Address
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Address Line | 527 EASTLAKE AVE E APT 101
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City | SEATTLE
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State | WA
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Zip | 98109-5567
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Country | US
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Telephone | 206-604-5549
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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 | MA 60169554
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License Number State | WA
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