Provider Demographics
NPI:1376185561
Name:WORST, NICHOLAS KANUI (LMT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:KANUI
Last Name:WORST
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BEACH LN SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-5703
Mailing Address - Country:US
Mailing Address - Phone:808-345-6340
Mailing Address - Fax:
Practice Address - Street 1:3 BEACH LN SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-5703
Practice Address - Country:US
Practice Address - Phone:808-345-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60720404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60720404OtherLICENSED MASSAGE THERAPIST