Provider Demographics
NPI:1316797087
Name:ROSENLUND, DELORA (LMT)
Entity type:Individual
Prefix:
First Name:DELORA
Middle Name:
Last Name:ROSENLUND
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 1:15504 NE GABRIEL RD
Mailing Address - Street 2:
Mailing Address - City:YACOLT
Mailing Address - State:WA
Mailing Address - Zip Code:98675-3516
Mailing Address - Country:US
Mailing Address - Phone:360-409-3454
Mailing Address - Fax:
Practice Address - Street 1:15504 NE GABRIEL RD
Practice Address - Street 2:
Practice Address - City:YACOLT
Practice Address - State:WA
Practice Address - Zip Code:98675-3516
Practice Address - Country:US
Practice Address - Phone:360-409-3454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61449257225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist