Provider Demographics
NPI:1295334266
Name:WALDNER, JOSEPHINE (LMT)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:WALDNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9409 DELTA LINE RD
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9766
Mailing Address - Country:US
Mailing Address - Phone:360-224-3091
Mailing Address - Fax:
Practice Address - Street 1:6046 PORTAL WAY STE 104
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-7829
Practice Address - Country:US
Practice Address - Phone:360-224-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61100177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty