Provider Demographics
NPI:1649499310
Name:FAIN, ANN E (LMT)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:E
Last Name:FAIN
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 1:22724 BRIARWOOD CT SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8982
Mailing Address - Country:US
Mailing Address - Phone:360-290-3376
Mailing Address - Fax:360-458-4399
Practice Address - Street 1:9144 BURNETT RD SE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8488
Practice Address - Country:US
Practice Address - Phone:360-292-9320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2019-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
WAMA00009789225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty