Provider Demographics
NPI:1346849775
Name:EIER, PHYLL (LMT)
Entity Type:Individual
Prefix:
First Name:PHYLL
Middle Name:
Last Name:EIER
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 1:22315 6TH AVE S UNIT B303
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6861
Mailing Address - Country:US
Mailing Address - Phone:206-513-6490
Mailing Address - Fax:
Practice Address - Street 1:22315 6TH AVE S UNIT B303
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6861
Practice Address - Country:US
Practice Address - Phone:206-513-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61054386225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty