Provider Demographics
NPI:1063616704
Name:ROSE, ANNELIESE CHRISTA (LMP)
Entity type:Individual
Prefix:MRS
First Name:ANNELIESE
Middle Name:CHRISTA
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6417 REBECCA CT SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8020
Mailing Address - Country:US
Mailing Address - Phone:253-632-6417
Mailing Address - Fax:
Practice Address - Street 1:500 SW 39TH ST STE 150
Practice Address - Street 2:HEALTH CARE MANAGEMENT
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4915
Practice Address - Country:US
Practice Address - Phone:253-264-2950
Practice Address - Fax:253-264-2591
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20841225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist