Provider Demographics
NPI:1801125737
Name:THOMAS, KERRI A (LMP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:A
Last Name:THOMAS
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 1:1905 24TH AVENUE CT SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1365
Mailing Address - Country:US
Mailing Address - Phone:253-318-6002
Mailing Address - Fax:
Practice Address - Street 1:11108 WOODLAND AVE E STE A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5893
Practice Address - Country:US
Practice Address - Phone:253-845-5358
Practice Address - Fax:253-845-5753
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60125270225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60125270OtherWA MASSAGE LICENSE