Provider Demographics
NPI:1447525365
Name:ROBERTS, CHIKA (LMP)
Entity type:Individual
Prefix:
First Name:CHIKA
Middle Name:
Last Name:ROBERTS
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 1:27312 107TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7065
Mailing Address - Country:US
Mailing Address - Phone:206-409-3537
Mailing Address - Fax:
Practice Address - Street 1:16810 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5413
Practice Address - Country:US
Practice Address - Phone:425-227-0111
Practice Address - Fax:425-228-2583
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60089612225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist