Organization
PHOENIXBODY WORKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JENNIFER DIANA ORTIZ MA00020960 (LMP)
(253) 880-7447
Entity
Organization
Contact information
Practice address
12815 CANYON RD E STE I, PUYALLUP, WA 98373-5104
(253) 880-7447
Mailing address
12815 CANYON RD E STE I, PUYALLUP, WA 98373-5104
(253) 880-7447
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA00020960
WA
Other
Enumeration date
11/17/2014
Last updated
11/17/2014
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