Provider Demographics
NPI:1528538527
Name:CHRISTENSEN-MANNEH, KATHI MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:MARIE
Last Name:CHRISTENSEN-MANNEH
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:PO BOX 3026
Mailing Address - Street 2:
Mailing Address - City:UNION GAP
Mailing Address - State:WA
Mailing Address - Zip Code:98903-0026
Mailing Address - Country:US
Mailing Address - Phone:425-761-2662
Mailing Address - Fax:
Practice Address - Street 1:269 LONE DOVE LN
Practice Address - Street 2:
Practice Address - City:UNION GAP
Practice Address - State:WA
Practice Address - Zip Code:98903-9726
Practice Address - Country:US
Practice Address - Phone:425-761-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
419229-00OtherNCBTM
ACH2006538OtherAMTA
WAMA00019918OtherWASHINGTON STATE DOH