MEDICARE: MS. JANN YVONNE COONS LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00012242	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0211042	OTHER	WA	L & I
2	MA00012242	OTHER	WA	DEPT OF HEALTH

General Provider Information

NPI Number	:	1124296025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANN YVONNE COONS LMP

Provider Business Mailing Address
First Line	:	2463 WOODS RD E
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-8309
Country	:	US
Telephone Number	:	206-349-6404
Fax Number	:

Provider Business Practice Location Address
First Line	:	3272 CALIFORNIA AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3375
Country	:	US
Telephone Number	:	206-349-6404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/13/2008

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