Provider Demographics
NPI:1629491139
Name:HART, PALESTEEN VANELL (MA60335498)
Entity Type:Individual
Prefix:
First Name:PALESTEEN
Middle Name:VANELL
Last Name:HART
Suffix:
Gender:F
Credentials:MA60335498
Other - Prefix:
Other - First Name:PALESTEEN
Other - Middle Name:VANELL
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA60335498
Mailing Address - Street 1:24001 56TH AVE W
Mailing Address - Street 2:SUITE D-404
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5558
Mailing Address - Country:US
Mailing Address - Phone:425-633-9458
Mailing Address - Fax:
Practice Address - Street 1:24001 56TH AVE W
Practice Address - Street 2:SUITE D-404
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5558
Practice Address - Country:US
Practice Address - Phone:425-633-9458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60335498174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60335498OtherMASSAGE PRACTITIONER LICENSE