Provider Demographics
NPI:1851855753
Name:BJERKE, KENYARI (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:KENYARI
Middle Name:
Last Name:BJERKE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 S 32ND ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5099
Mailing Address - Country:US
Mailing Address - Phone:612-423-4232
Mailing Address - Fax:
Practice Address - Street 1:4300 TALBOT RD S STE 304
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6238
Practice Address - Country:US
Practice Address - Phone:425-264-5060
Practice Address - Fax:877-204-0172
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60899124225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist