Provider Demographics
NPI:1649313156
Name:RICE, CHRISTY (LMP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:LMP
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 370
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-0370
Mailing Address - Country:US
Mailing Address - Phone:360-275-8727
Mailing Address - Fax:360-275-9695
Practice Address - Street 1:151 NE STATE RT 300
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528
Practice Address - Country:US
Practice Address - Phone:360-275-8727
Practice Address - Fax:360-275-9695
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021708225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0203832OtherLABOR AND INDUSTRIES
WA20400778602OtherKPS HEALTH PLANS