Provider Demographics
NPI:1760683775
Name:ZANIEWSKI, DELILAH MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:DELILAH
Middle Name:MARIE
Last Name:ZANIEWSKI
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 505
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-0505
Mailing Address - Country:US
Mailing Address - Phone:360-790-5580
Mailing Address - Fax:360-426-3787
Practice Address - Street 1:130 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3533
Practice Address - Country:US
Practice Address - Phone:360-790-5580
Practice Address - Fax:360-426-3787
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011564225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA123486OtherLABOR AND INDUSTRIES