Provider Demographics
NPI:1366692196
Name:PRICE, MISTY KRISTINE (LMT)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:KRISTINE
Last Name:PRICE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:
Other - Last Name:SCARPELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 S 47TH AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-7781
Mailing Address - Country:US
Mailing Address - Phone:360-989-8517
Mailing Address - Fax:360-368-3789
Practice Address - Street 1:255 S 47TH AVE STE 125
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-7781
Practice Address - Country:US
Practice Address - Phone:360-989-8517
Practice Address - Fax:360-368-3789
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024318225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist