Provider Demographics
NPI:1043427644
Name:HUESKE, CHRISTINA (LMP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:HUESKE
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 1:1304 MAY AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-3948
Mailing Address - Country:US
Mailing Address - Phone:360-490-3927
Mailing Address - Fax:
Practice Address - Street 1:701 S 1ST ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3601
Practice Address - Country:US
Practice Address - Phone:360-490-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist