Doctor Name: | THOMAS WALLACE |
NPI Number: | 1023499217 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMP |
License Number: | MA00007689 |
Business Practice Address: | 17205 Vashon Hwy Sw Suite B2 Vashon, WA - 980704674 |
Business Phone Number: | 2064631850 |
Business Fax Number: | 2064631852 |
Mailing Address: | Po Box 299, VASHON |
State: | WA |
Postal Code: | 980700299 |
Phone Number: | 2064631850 |
Fax Number: | 2064631852 |
NPI Enumeration Date: | 06/12/2015 |
NPI Last Update Date: | 06/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA00007689 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |