Provider Demographics
NPI:1124256987
Name:REID, DENISE M (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:REID
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17528 MERIDIAN E SUITE 207
Mailing Address - Street 2:NADER FAMILY CHIROPRACTIC
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375
Mailing Address - Country:US
Mailing Address - Phone:253-445-9030
Mailing Address - Fax:253-445-9031
Practice Address - Street 1:1707 3RD ST SE SUITE A
Practice Address - Street 2:NADER FAMILY CHIROPRACTIC
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375
Practice Address - Country:US
Practice Address - Phone:253-200-2355
Practice Address - Fax:253-200-2977
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00021066225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist