MEDICARE: MRS. ROYAL B BOOKER L.M.P.

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	MA00001728	WA

General Provider Information

NPI Number	:	1184778243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROYAL B BOOKER L.M.P.

Provider Business Mailing Address
First Line	:	753 N 35TH ST
Second Line	:	STE 101
City	:	SEATTLE
State	:	WA
Zip	:	98103-8870
Country	:	US
Telephone Number	:	206-632-3226
Fax Number	:	206-267-3106

Provider Business Practice Location Address
First Line	:	753 N 35TH ST
Second Line	:	STE 101
City	:	SEATTLE
State	:	WA
Zip	:	98103-8870
Country	:	US
Telephone Number	:	206-632-3226
Fax Number	:	206-267-3106

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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