Provider Demographics
NPI:1942488184
Name:THOMAS, REBECCA ELLEN (LMP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ELLEN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:ELLEN
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:500 W. MAIN ST.
Mailing Address - Street 2:SUITE D
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531
Mailing Address - Country:US
Mailing Address - Phone:360-918-1134
Mailing Address - Fax:360-623-1215
Practice Address - Street 1:500 W. MAIN ST.
Practice Address - Street 2:SUITE D
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531
Practice Address - Country:US
Practice Address - Phone:360-918-1134
Practice Address - Fax:360-623-1215
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023668225700000X
WAMA#00023668225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist