Provider Demographics
NPI:1477863728
Name:GREEN-TAYLOR, ELIZABETH A (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GREEN-TAYLOR
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 1:204 PINEHURST DR SW
Mailing Address - Street 2:103
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4500
Mailing Address - Country:US
Mailing Address - Phone:360-352-8112
Mailing Address - Fax:
Practice Address - Street 1:204 PINEHURST DR SW
Practice Address - Street 2:103
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4500
Practice Address - Country:US
Practice Address - Phone:360-352-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019378172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist