Provider Demographics
NPI:1972781342
Name:RICHARDS, CATRINA LILLIAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CATRINA
Middle Name:LILLIAN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CATRINA
Other - Middle Name:L
Other - Last Name:WYLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22910 E APPLEWAY AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8606
Mailing Address - Country:US
Mailing Address - Phone:509-344-9199
Mailing Address - Fax:
Practice Address - Street 1:22910 E APPLEWAY AVE STE 7
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019
Practice Address - Country:US
Practice Address - Phone:509-344-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024702225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist