Provider Demographics
NPI:1700024270
Name:RINKER, CARLA (LMP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:RINKER
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 1:2723 RIVER VISTA LOOP
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-8595
Mailing Address - Country:US
Mailing Address - Phone:360-708-6292
Mailing Address - Fax:
Practice Address - Street 1:2108 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5406
Practice Address - Country:US
Practice Address - Phone:360-428-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018119225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist