Doctor Name: | JACKIE C BORUP |
NPI Number: | 1932500873 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | |
Business Practice Address: | 226 W 3rd Ave Moses Lake, WA - 988371933 |
Business Phone Number: | 5097654174 |
Business Fax Number: | |
Mailing Address: | 117 E Inglewood Dr, MOSES LAKE |
State: | WA |
Postal Code: | 988372561 |
Phone Number: | 5094315824 |
Fax Number: | |
NPI Enumeration Date: | 09/10/2014 |
NPI Last Update Date: | 09/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | |
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. |