Provider Demographics
NPI:1659762201
Name:NUMKENA, DOROTHY (LMP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:NUMKENA
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 1:8811 S TACOMA WAY
Mailing Address - Street 2:STE 104
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4595
Mailing Address - Country:US
Mailing Address - Phone:253-581-8444
Mailing Address - Fax:
Practice Address - Street 1:8811 S TACOMA WAY
Practice Address - Street 2:STE 104
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4595
Practice Address - Country:US
Practice Address - Phone:253-581-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60018855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist