Individual
DEDERA A MIDDERHOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
4111 S. MERIDIAN, SUITE F, PUYALLUP, WA 98374
(253) 273-2792
Mailing address
12310 109TH AVE CT E, PUYALLUP, WA 98374
(253) 273-2792
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00020763
WA
Other
Enumeration date
02/13/2007
Last updated
07/08/2007
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