Provider Demographics
NPI:1710408968
Name:EASLEY, CELYNA DAYANARA (LMP)
Entity Type:Individual
Prefix:
First Name:CELYNA
Middle Name:DAYANARA
Last Name:EASLEY
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:PO BOX 1679
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-1679
Mailing Address - Country:US
Mailing Address - Phone:253-652-9264
Mailing Address - Fax:
Practice Address - Street 1:27020 PACIFIC HWY S STE B
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-6951
Practice Address - Country:US
Practice Address - Phone:253-839-2225
Practice Address - Fax:253-839-1424
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60769589225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist