Provider Demographics
NPI:1164741435
Name:BETH-JUDDAH, KATHERINE (LMP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BETH-JUDDAH
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 1:2310 MILDRED ST W
Mailing Address - Street 2:#100C
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6036
Mailing Address - Country:US
Mailing Address - Phone:253-564-2920
Mailing Address - Fax:253-564-0135
Practice Address - Street 1:2310 MILDRED ST W
Practice Address - Street 2:#100C
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-6036
Practice Address - Country:US
Practice Address - Phone:253-564-2920
Practice Address - Fax:253-564-0135
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013468225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist