Provider Demographics
NPI:1508046228
Name:WEBER, CORALLEE ELIZABETH (LMP)
Entity Type:Individual
Prefix:MRS
First Name:CORALLEE
Middle Name:ELIZABETH
Last Name:WEBER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:CORALLEE
Other - Middle Name:ELIZABETH
Other - Last Name:KOWALLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 K ST NE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1747
Mailing Address - Country:US
Mailing Address - Phone:253-905-6761
Mailing Address - Fax:253-231-3475
Practice Address - Street 1:111 K ST NE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1747
Practice Address - Country:US
Practice Address - Phone:253-905-6761
Practice Address - Fax:253-231-3475
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024666175L00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No175L00000XOther Service ProvidersHomeopath