Individual
ELIJAH REUBEN ROQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
19220 74TH AVE W, LYNNWOOD, WA 98036-5063
(425) 314-9901
Mailing address
19220 74TH AVE W, LYNNWOOD, WA 98036-5063
(425) 314-9901
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA6059228
WA
Other
Enumeration date
09/25/2015
Last updated
09/25/2015
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