Provider Demographics
NPI:1851500375
Name:DANCE, KATRINA DEANE (LMP)
Entity Type:Individual
Prefix:MS
First Name:KATRINA
Middle Name:DEANE
Last Name:DANCE
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 1:2524 16TH AVE S
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-5104
Mailing Address - Country:US
Mailing Address - Phone:206-322-9500
Mailing Address - Fax:
Practice Address - Street 1:2524 16TH AVE S
Practice Address - Street 2:SUITE 311
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-5104
Practice Address - Country:US
Practice Address - Phone:206-322-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist