MEDICARE: EMBODIED WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist
2	171100000X	Acupuncturist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1093352312	OTHER		ACUPUNCTURE
2	AC61094788	OTHER	WA	WA ACUPUNCTURE LICENSE

General Provider Information

NPI Number	:	1497494355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBODIED WELLNESS LLC

Provider Business Mailing Address
First Line	:	6107 N ASTOR ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-8102
Country	:	US
Telephone Number	:	509-968-1679
Fax Number	:	509-960-9003

Provider Business Practice Location Address
First Line	:	6107 N ASTOR ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-8102
Country	:	US
Telephone Number	:	509-210-0550
Fax Number	:	509-960-9003

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	NEREA KEESEE
Credential	:	L.AC., EAMP
Telephone Number	:	509-210-0550

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	04/09/2025

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Directions to “EMBODIED WELLNESS LLC ” Practice Location

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