Provider Demographics
NPI:1063997120
Name:WUTZKE, NATALIE SUSANNE (LMT)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:SUSANNE
Last Name:WUTZKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7545 VAN BELLE RD
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-9697
Mailing Address - Country:US
Mailing Address - Phone:509-391-5822
Mailing Address - Fax:
Practice Address - Street 1:7545 VAN BELLE RD
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-9697
Practice Address - Country:US
Practice Address - Phone:509-391-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60860173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist