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General NPI Number Information
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NPI Number | 1861354144
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Entity Type | Individual
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Provider Name | CEARA NICOLE GENTRY LMT
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Gender | Female
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 812 39TH AVE SW STE A
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City | PUYALLUP
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State | WA
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Zip | 98373-5915
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Country | US
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Telephone | 253-268-0686
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Fax |
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Provider Business Mailing Address
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Address Line | 13327 108TH AVE E
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City | PUYALLUP
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State | WA
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Zip | 98374-5615
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Country | US
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Telephone |
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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 | MA60769590
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License Number State | WA
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