Provider Demographics
NPI:1265075634
Name:PURVIS, DAKOTA (LMT)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:
Last Name:PURVIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:SPANGLE
Mailing Address - State:WA
Mailing Address - Zip Code:99031-0146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20030 S SPANGLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SPANGLE
Practice Address - State:WA
Practice Address - Zip Code:99031-9704
Practice Address - Country:US
Practice Address - Phone:509-570-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60639494225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist