Individual
GEORGIA ANNE IDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
12951 BEL RED RD STE 100, BELLEVUE, WA 98005-2628
(425) 786-3086
Mailing address
20229 150TH AVE SE, MONROE, WA 98272-9132
(425) 786-3086
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60247950
WA
Other
Enumeration date
11/01/2011
Last updated
07/23/2013
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