Provider Demographics
NPI:1083185680
Name:FRY, RACHEL ANNE (ND, LMT)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ANNE
Last Name:FRY
Suffix:
Gender:F
Credentials:ND, LMT
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:HANKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22926 105TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-8056
Mailing Address - Country:US
Mailing Address - Phone:217-209-2977
Mailing Address - Fax:
Practice Address - Street 1:18530 156TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8409
Practice Address - Country:US
Practice Address - Phone:425-489-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-08
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60511096225700000X
WANT60903793175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist