Doctor Name: | CARLA BONE PRIDDY |
NPI Number: | 1114390168 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA60479768 |
Business Practice Address: | 12504 Nw 36th Ave Vancouver, WA - 986852227 |
Business Phone Number: | 3608365317 |
Business Fax Number: | |
Mailing Address: | 2712 Nw 118th Circle, VANCOUVER |
State: | WA |
Postal Code: | 98685 |
Phone Number: | 3608365317 |
Fax Number: | |
NPI Enumeration Date: | 11/12/2015 |
NPI Last Update Date: | 11/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA60479768 |
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. |