Provider Demographics
NPI:1306656517
Name:BROOKS, SELENA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2709
Mailing Address - Country:US
Mailing Address - Phone:509-736-2225
Mailing Address - Fax:509-736-3366
Practice Address - Street 1:3603 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2709
Practice Address - Country:US
Practice Address - Phone:509-736-2225
Practice Address - Fax:509-736-3366
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61641182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist