Provider Demographics
NPI:1063007730
Name:POWERS, STATA JOAN (LMT)
Entity Type:Individual
Prefix:
First Name:STATA
Middle Name:JOAN
Last Name:POWERS
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 1:1350 MEDICINE VALLEY RD
Mailing Address - Street 2:PO BOX 607
Mailing Address - City:WHITE SWAN
Mailing Address - State:WA
Mailing Address - Zip Code:98952-0607
Mailing Address - Country:US
Mailing Address - Phone:509-731-1588
Mailing Address - Fax:
Practice Address - Street 1:134 KEENE RD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-8683
Practice Address - Country:US
Practice Address - Phone:509-628-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61105009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist