Provider Demographics
NPI:1649935248
Name:BLUFF BOPP, KAT R (LMT)
Entity type:Individual
Prefix:
First Name:KAT
Middle Name:R
Last Name:BLUFF BOPP
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 1:2312 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1636
Mailing Address - Country:US
Mailing Address - Phone:602-716-1174
Mailing Address - Fax:
Practice Address - Street 1:124 E ROWAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1214
Practice Address - Country:US
Practice Address - Phone:509-487-8000
Practice Address - Fax:509-487-6333
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61167718225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA61167718OtherDEPARTMENT OF HEALTH