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General NPI Number Information
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NPI Number | 1861568883
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Entity Type | Individual
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Provider Name | SUNNY WALLIS BIRDSTONE LMP
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 821 HARVEY RD
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City | AUBURN
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State | WA
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Zip | 98002-4225
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Country | US
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Telephone | 253-833-1833
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Fax | 253-833-4642
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Provider Business Mailing Address
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Address Line | 3250 S 77TH ST LOT 8
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City | TACOMA
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State | WA
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Zip | 98409-5061
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Country | US
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Telephone | 253-473-3400
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Fax | 253-476-1530
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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 | MA9942
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License Number State | WA
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