Individual
MS. CORENA ELANE BALLANTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
121 NE DRAGONFLY LN, BELFAIR, WA 98528-8423
(360) 552-2078
Mailing address
121 NE DRAGONFLY LN, BELFAIR, WA 98528-8423
(360) 552-2078
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA 60204641
WA
Other
Enumeration date
05/09/2011
Last updated
05/09/2011
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