Provider Demographics
NPI:1003582396
Name:RYAN, KAREN JILL (LMT LICENSED MASSAGE)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JILL
Last Name:RYAN
Suffix:
Gender:F
Credentials:LMT LICENSED MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 366
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122
Mailing Address - Country:US
Mailing Address - Phone:509-439-3050
Mailing Address - Fax:
Practice Address - Street 1:42031 LAKEVIEW DR. N
Practice Address - Street 2:
Practice Address - City:DEER MEADOWS
Practice Address - State:WA
Practice Address - Zip Code:99122
Practice Address - Country:US
Practice Address - Phone:509-439-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61179279225700000X
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist