Basic Information
| Provider Information | |||||||||
| NPI: | 1760810402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TURNER | ||||||||
| FirstName: | IVY | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| OtherLastName: | BRAACK | ||||||||
| OtherFirstName: | IVY | ||||||||
| OtherMiddleName: | KATHLEEN | ||||||||
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| OtherCredential: | LMP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3811 NE 3RD CT | ||||||||
| Address2: | APT G111 | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980564145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182616902 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 670 NW GILMAN BLVD | ||||||||
| Address2: | SUITE B2 | ||||||||
| City: | ISSAQUAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980272444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254276562 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2013 | ||||||||
| LastUpdateDate: | 10/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA60387401 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.