Provider Demographics
NPI:1487014684
Name:RAINWATER, LA'TINA MARIE
Entity Type:Individual
Prefix:
First Name:LA'TINA
Middle Name:MARIE
Last Name:RAINWATER
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 1:101 E MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1519
Mailing Address - Country:US
Mailing Address - Phone:360-863-0642
Mailing Address - Fax:360-794-7236
Practice Address - Street 1:1801 NW MARKET ST STE 408
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3901
Practice Address - Country:US
Practice Address - Phone:206-784-2800
Practice Address - Fax:206-784-5257
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA-60636021225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist