Provider Demographics
NPI:1457612665
Name:NEWBOLD, VALERIE BRENDA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:BRENDA
Last Name:NEWBOLD
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8324 NE 120TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5824
Mailing Address - Country:US
Mailing Address - Phone:206-890-3154
Mailing Address - Fax:
Practice Address - Street 1:8324 NE 120TH PL
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5824
Practice Address - Country:US
Practice Address - Phone:206-890-3154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60267139225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist