Provider Demographics
NPI:1164742706
Name:ERICKSON, BETHANY JOANNE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOANNE
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9215 219TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-9290
Mailing Address - Country:US
Mailing Address - Phone:406-531-3526
Mailing Address - Fax:253-375-6688
Practice Address - Street 1:400 E PIONEER STE 202
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3257
Practice Address - Country:US
Practice Address - Phone:406-531-3526
Practice Address - Fax:253-375-6688
Is Sole Proprietor?:No
Enumeration Date:2010-06-05
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60146324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist