Provider Demographics
NPI:1306903653
Name:WOODBURY, SHEILA MARIE (LMP)
Entity type:Individual
Prefix:MISS
First Name:SHEILA
Middle Name:MARIE
Last Name:WOODBURY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 N DIVISION
Mailing Address - Street 2:#103
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218
Mailing Address - Country:US
Mailing Address - Phone:509-326-4122
Mailing Address - Fax:509-326-4122
Practice Address - Street 1:9505 N DIVISION
Practice Address - Street 2:#103 ADVANCED HEALTH THERAPEUTIC MASSAGE
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218
Practice Address - Country:US
Practice Address - Phone:509-326-4122
Practice Address - Fax:509-326-4122
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021741225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist