Provider Demographics
NPI:1932877453
Name:LIPKA, RHONDA M (LMT)
Entity Type:Individual
Prefix:MR
First Name:RHONDA
Middle Name:M
Last Name:LIPKA
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:YACOLT
Mailing Address - State:WA
Mailing Address - Zip Code:98675-0299
Mailing Address - Country:US
Mailing Address - Phone:360-600-1866
Mailing Address - Fax:
Practice Address - Street 1:311 N AMBOY AVE
Practice Address - Street 2:
Practice Address - City:YACOLT
Practice Address - State:WA
Practice Address - Zip Code:98675-5442
Practice Address - Country:US
Practice Address - Phone:360-600-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61098096225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA61098096OtherMASSAGE LICENSE