Provider Demographics
NPI:1164978714
Name:GULIE, STEPHANIE VICTORIA (MASSAGE PRACTIONER)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:VICTORIA
Last Name:GULIE
Suffix:
Gender:F
Credentials:MASSAGE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 186TH ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445
Mailing Address - Country:US
Mailing Address - Phone:206-799-7564
Mailing Address - Fax:
Practice Address - Street 1:2710 186TH ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445
Practice Address - Country:US
Practice Address - Phone:206-799-7564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60678933225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist