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General NPI Number Information
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NPI Number | 1891262531
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Entity Type | Individual
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Provider Name | VANESSA DIANE WALTERS LMT
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Gender | Female
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 4009 BRIDGEPORT WAY W STE E-7
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4326
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Country | US
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Telephone | 253-237-3331
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Fax |
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Provider Business Mailing Address
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Address Line | 2911 199TH AVENUE CT E
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City | LAKE TAPPS
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State | WA
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Zip | 98391-9067
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Country | US
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Telephone | 206-430-0020
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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 | MA60863848
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License Number State | WA
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