Doctor Name: | ALLISON CLARK |
NPI Number: | 1962671859 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMP |
License Number: | MA00021898 |
Business Practice Address: | 1611 Kresky Ave Ste 108 Suite A Centralia, WA - 985318982 |
Business Phone Number: | 3603301800 |
Business Fax Number: | 3603305866 |
Mailing Address: | 219 Downing Rd, CENTRALIA |
State: | WA |
Postal Code: | 985315605 |
Phone Number: | 3607362853 |
Fax Number: | 3607364159 |
NPI Enumeration Date: | 02/25/2008 |
NPI Last Update Date: | 03/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA00021898 |
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. |