Provider Demographics
NPI:1619444031
Name:WHITE, AIYANA AISHA TARYN (LMT)
Entity Type:Individual
Prefix:
First Name:AIYANA
Middle Name:AISHA TARYN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 12TH AVE W APT I204
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-1155
Mailing Address - Country:US
Mailing Address - Phone:253-495-7659
Mailing Address - Fax:
Practice Address - Street 1:525 5TH AVE S STE 102
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3612
Practice Address - Country:US
Practice Address - Phone:425-279-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60887822225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist