Provider Demographics
NPI:1376989673
Name:TORRES, KIRSTIN FOSSUM (LMP)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:FOSSUM
Last Name:TORRES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11645 SE 208TH ST APT 14
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-1687
Mailing Address - Country:US
Mailing Address - Phone:206-383-3938
Mailing Address - Fax:
Practice Address - Street 1:109 2ND AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5850
Practice Address - Country:US
Practice Address - Phone:206-383-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60232251225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist