Provider Demographics
NPI:1578897500
Name:IMMANUEL, HOSEA I (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:HOSEA
Middle Name:
Last Name:IMMANUEL
Suffix:I
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 MERIDIAN E STE A
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9328
Mailing Address - Country:US
Mailing Address - Phone:253-952-2001
Mailing Address - Fax:
Practice Address - Street 1:624 MERIDIAN E STE A
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9328
Practice Address - Country:US
Practice Address - Phone:253-952-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60036633225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist