MEDICARE: LWJH LLC OLYMPIC DAY SPA

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	MA00020688	WA
2	225700000X	Massage Therapist	MA00018677	WA
3	225700000X	Massage Therapist	MA00022101	WA
4	225700000X	Massage Therapist	MA00012444	WA
5	225700000X	Massage Therapist		WA
6	225700000X	Massage Therapist		WA
7	225700000X	Massage Therapist		WA

General Provider Information

NPI Number	:	1760541031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LWJH LLC OLYMPIC DAY SPA

Provider Business Mailing Address
First Line	:	PO BOX 2706
Second Line	:
City	:	POULSBO
State	:	WA
Zip	:	98370-2706
Country	:	US
Telephone Number	:	360-697-3767
Fax Number	:	360-697-5927

Provider Business Practice Location Address
First Line	:	11820 FRONT ST
Second Line	:	220
City	:	POULSBO
State	:	WA
Zip	:	98370
Country	:	US
Telephone Number	:	360-697-3767
Fax Number	:	360-697-5927

Authorized Official
Title or Position	:	MASSAGE THERIPAST FRONT DESK
Name	:	KIM WHITE
Credential	:	L.M.P
Telephone Number	:	360-697-3767

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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Directions to “LWJH LLC OLYMPIC DAY SPA ” Practice Location

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