Provider Demographics
NPI:1952801714
Name:PERCIFIELD, JUTTA MARIA
Entity Type:Individual
Prefix:
First Name:JUTTA
Middle Name:MARIA
Last Name:PERCIFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 S PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9294
Mailing Address - Country:US
Mailing Address - Phone:360-687-1781
Mailing Address - Fax:360-687-8458
Practice Address - Street 1:113 S PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9294
Practice Address - Country:US
Practice Address - Phone:360-687-1781
Practice Address - Fax:360-687-8458
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60257339225700000X
AZMT-16843225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist