Provider Demographics
NPI:1730392978
Name:PORTCH, ROWENA BELLE (LMP, LAMP)
Entity type:Individual
Prefix:MRS
First Name:ROWENA
Middle Name:BELLE
Last Name:PORTCH
Suffix:
Gender:F
Credentials:LMP, LAMP
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 2778
Mailing Address - Street 2:3521 NW PRINCETON LANE, 12-103
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-2778
Mailing Address - Country:US
Mailing Address - Phone:360-229-3470
Mailing Address - Fax:
Practice Address - Street 1:2400 NW MYHRE RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7672
Practice Address - Country:US
Practice Address - Phone:360-229-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024197174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00024197OtherMASSAGE THERAPIST