Provider Demographics
NPI:1679738751
Name:WOODS, KATIE N (LMP)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:N
Last Name:WOODS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:N
Other - Last Name:FOSBURG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3415 S GILLIS RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5842
Mailing Address - Country:US
Mailing Address - Phone:509-979-1056
Mailing Address - Fax:
Practice Address - Street 1:104 S FREYA ST GREEN FLAG BUILDING SUITE 112-A
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4870
Practice Address - Country:US
Practice Address - Phone:501-291-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
WAMA00023616225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist