Provider Demographics
NPI:1871586743
Name:ZORNES, CAROL A (LMP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:ZORNES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:ROBERTS AND ZIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 731269
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0060
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:21806 103RD AVENUE CT E
Practice Address - Street 2:#202
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8115
Practice Address - Country:US
Practice Address - Phone:253-847-3700
Practice Address - Fax:253-847-9622
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8933653OtherCRIME VICTIMS
WA174539OtherDEPT OF L&I
WA8845ZOOtherREGENCE B/S