Individual
CARL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
12345 ROOSEVELT WAY NE APT 304, SEATTLE, WA 98125-4867
(206) 427-7084
Mailing address
12345 ROOSEVELT WAY NE APT 304, SEATTLE, WA 98125-4867
(206) 427-7084
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00005063
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA00005063
LICENSED MASSAGE THERAPIST
WA
Enumeration date
06/26/2020
Last updated
06/26/2020
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