Provider Demographics
NPI:1255724241
Name:HAASE, RACHAEL (MASSAGE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:HAASE
Suffix:
Gender:F
Credentials:MASSAGE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 NE 164TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-0750
Mailing Address - Country:US
Mailing Address - Phone:360-609-7372
Mailing Address - Fax:
Practice Address - Street 1:1419 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9830
Practice Address - Country:US
Practice Address - Phone:360-666-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020508175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath