Provider Demographics
NPI:1063657682
Name:WALTON, ALICIA (LMT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WALTON
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 1:19215 SE 34TH ST., STE 102
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607
Mailing Address - Country:UM
Mailing Address - Phone:360-882-7733
Mailing Address - Fax:360-254-6821
Practice Address - Street 1:19215 SE 34TH ST STE 102
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-8830
Practice Address - Country:US
Practice Address - Phone:360-882-7733
Practice Address - Fax:360-254-6821
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022526225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist