Provider Demographics
NPI:1396301339
Name:AVALLAH, ZAKIAH L (LMT)
Entity type:Individual
Prefix:
First Name:ZAKIAH
Middle Name:L
Last Name:AVALLAH
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 1:4517 DECATUR DR
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-9571
Mailing Address - Country:US
Mailing Address - Phone:360-393-2034
Mailing Address - Fax:
Practice Address - Street 1:410 W BAKERVIEW RD STE 110-RM 124
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8106
Practice Address - Country:US
Practice Address - Phone:360-393-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008514225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist