Provider Demographics
NPI:1497020911
Name:POTTS-RAY, DENISE J (LMP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:J
Last Name:POTTS-RAY
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 1:1001 SUMMITVIEW AVENUE, SUITE 6
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3023
Mailing Address - Country:US
Mailing Address - Phone:509-453-0300
Mailing Address - Fax:509-452-0890
Practice Address - Street 1:1001 SUMMITVIEW AVENUE, SUITE 6
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3023
Practice Address - Country:US
Practice Address - Phone:509-453-0300
Practice Address - Fax:509-452-0890
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60175374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist