Provider Demographics
NPI:1962038497
Name:BOZE, ELIZABETH ANNETTE (MA 60817330)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNETTE
Last Name:BOZE
Suffix:
Gender:F
Credentials:MA 60817330
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 N CHERRY ST APT E106
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-5015
Mailing Address - Country:US
Mailing Address - Phone:509-680-3806
Mailing Address - Fax:
Practice Address - Street 1:101 E HASTINGS RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-4901
Practice Address - Country:US
Practice Address - Phone:509-340-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60817330225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist