Provider Demographics
NPI:1952566929
Name:DORN, WHITNEY MACRAE (LMT)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MACRAE
Last Name:DORN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:VIDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 SE SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9286
Mailing Address - Country:US
Mailing Address - Phone:360-791-0194
Mailing Address - Fax:
Practice Address - Street 1:2633 PARKMONT LN SW STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5751
Practice Address - Country:US
Practice Address - Phone:360-791-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020116225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist