Provider Demographics
NPI:1124795737
Name:NELSON, JUNE COPPER (LMT)
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:COPPER
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:CHRISTINA
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3841 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2125
Mailing Address - Country:US
Mailing Address - Phone:253-203-8825
Mailing Address - Fax:
Practice Address - Street 1:3841 S 10TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2125
Practice Address - Country:US
Practice Address - Phone:253-203-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61201120225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist