Provider Demographics
NPI:1205160421
Name:MOSS, RUTH KIM ANN (BA, PBP, LMP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:KIM ANN
Last Name:MOSS
Suffix:
Gender:F
Credentials:BA, PBP, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 CAPITOL WAY S
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3326
Mailing Address - Country:US
Mailing Address - Phone:707-688-6032
Mailing Address - Fax:
Practice Address - Street 1:2621 CAPITOL WAY S
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-3326
Practice Address - Country:US
Practice Address - Phone:707-688-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60043686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist