Provider Demographics
NPI:1417185968
Name:VIXIE, BEATA
Entity Type:Individual
Prefix:
First Name:BEATA
Middle Name:
Last Name:VIXIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 NE HICKMAN CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1230 NE HICKMAN CT
Practice Address - Street 2:SUITE 1
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5617
Practice Address - Country:US
Practice Address - Phone:509-432-5053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60100417225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist