Individual
ALAN D BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
1208 S 7TH ST, SHELTON, WA 98584-2710
(360) 432-7834
Mailing address
1208 S 7TH ST, SHELTON, WA 98584-2710
(360) 432-7834
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00007761
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA00007761
WA STATE MASSAGE LICENSE #
—
Enumeration date
01/12/2009
Last updated
01/12/2009
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