Doctor Name: | MR. SUNRISE MOONSHADOW COULTER |
NPI Number: | 1811323801 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT, LMP |
License Number: | 18466 |
Business Practice Address: | 542 N 5th Ave Sequim, WA - 983823079 |
Business Phone Number: | 3606837911 |
Business Fax Number: | |
Mailing Address: | Po Box 853, PORT TOWNSEND |
State: | WA |
Postal Code: | 983680853 |
Phone Number: | 5413060565 |
Fax Number: | |
NPI Enumeration Date: | 09/23/2013 |
NPI Last Update Date: | 09/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 18466 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OR |
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. |