Provider Demographics
NPI:1407621683
Name:KIM, CARRIE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 FORT DENT WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2595
Mailing Address - Country:US
Mailing Address - Phone:206-591-0722
Mailing Address - Fax:
Practice Address - Street 1:6840 FORT DENT WAY STE 120
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2595
Practice Address - Country:US
Practice Address - Phone:206-809-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2024-03-25
Deactivation Date:2024-03-18
Deactivation Code:
Reactivation Date:2024-03-25
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
WAMA61505898225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist