Provider Demographics
NPI:1619050887
Name:RICHARDS, CHRISTINE LOUISE (LMP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:RICHARDS
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 1:5322 SEAHAWK DR
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-9115
Mailing Address - Country:US
Mailing Address - Phone:509-392-1271
Mailing Address - Fax:
Practice Address - Street 1:5322 SEAHAWK DR
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-9115
Practice Address - Country:US
Practice Address - Phone:509-392-1271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020083225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00020083OtherMASSAGE PRACTITIONER L. #
WA601562783OtherUNIFIED BUSINESS ID #