MEDICARE: RUTH KIM ANN MOSS BA, PBP, 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	MA 60043686	WA

General Provider Information

NPI Number	:	1205160421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH KIM ANN MOSS BA, PBP, LMP

Provider Business Mailing Address
First Line	:	2621 CAPITOL WAY S
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-3326
Country	:	US
Telephone Number	:	707-688-6032
Fax Number	:

Provider Business Practice Location Address
First Line	:	2621 CAPITOL WAY S
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-3326
Country	:	US
Telephone Number	:	707-688-6032
Fax Number	:

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

Provider Enumeration Date	:	09/21/2009
Last Update Date	:	03/24/2022

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