Doctor Name: | MISS DOMINIQUE JENELLE CLOTHIAUX |
NPI Number: | 1770635203 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA00020937 |
Business Practice Address: | 106 E 3rd St Ste 2c Moscow, ID - 838432970 |
Business Phone Number: | 2085960539 |
Business Fax Number: | |
Mailing Address: | 312 E 2nd St Apt 2, MOSCOW |
State: | ID |
Postal Code: | 838432878 |
Phone Number: | 2085960539 |
Fax Number: | |
NPI Enumeration Date: | 01/17/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA00020937 |
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. |