Provider Demographics
NPI:1730230780
Name:TRAYLOR, DENISE (LMP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:TRAYLOR
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 1:4215 CONVENTION PL
Mailing Address - Street 2:STUITE B
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8148
Mailing Address - Country:US
Mailing Address - Phone:509-545-1010
Mailing Address - Fax:509-545-1112
Practice Address - Street 1:4215 CONVENTION PL
Practice Address - Street 2:STUITE B
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8148
Practice Address - Country:US
Practice Address - Phone:509-545-1010
Practice Address - Fax:509-545-1112
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003244225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist