Provider Demographics
NPI:1134479207
Name:ROSE, RIKKI MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:RIKKI
Middle Name:MARIE
Last Name:ROSE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:RIKKI
Other - Middle Name:MARIE
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:113 S PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9294
Mailing Address - Country:US
Mailing Address - Phone:360-687-1781
Mailing Address - Fax:360-687-8458
Practice Address - Street 1:113 S PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9294
Practice Address - Country:US
Practice Address - Phone:360-687-1781
Practice Address - Fax:360-687-8458
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012037225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist