Provider Demographics
NPI:1255500922
Name:PHELPS, JOANIE RAE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JOANIE
Middle Name:RAE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 1406
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022
Mailing Address - Country:US
Mailing Address - Phone:425-531-4894
Mailing Address - Fax:
Practice Address - Street 1:1724 COLE ST STE 6
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022
Practice Address - Country:US
Practice Address - Phone:425-531-4894
Practice Address - Fax:425-433-0733
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist