Individual
DEENA Y GERASIMOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14415 74TH STREET CT E, SUMNER, WA 98390-8274
(253) 245-8914
Mailing address
14415 74TH STREET CT E, SUMNER, WA 98390-8274
(253) 245-8914
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60689818
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MA60689818
—
WA
Enumeration date
01/30/2017
Last updated
01/30/2017
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