Provider Demographics
NPI:1730324716
Name:SONGHURST, KRISTINE KEIKO (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:KEIKO
Last Name:SONGHURST
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 1:1103 W MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4459
Mailing Address - Country:US
Mailing Address - Phone:509-599-6033
Mailing Address - Fax:
Practice Address - Street 1:1103 W MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4459
Practice Address - Country:US
Practice Address - Phone:509-599-6033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023662225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist