MEDICARE: THREE RIVERS THERAPEUTIC MASSAGE 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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1962792796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE RIVERS THERAPEUTIC MASSAGE LLC

Provider Business Mailing Address
First Line	:	6722 W KENNEWICK AVE
Second Line	:	SUITE B
City	:	KENNEWICK
State	:	WA
Zip	:	99336-1793
Country	:	US
Telephone Number	:	509-619-0996
Fax Number	:

Provider Business Practice Location Address
First Line	:	6722 W KENNEWICK AVE
Second Line	:	SUITE B
City	:	KENNEWICK
State	:	WA
Zip	:	99336-1793
Country	:	US
Telephone Number	:	509-619-0996
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/BUS. MANAGER
Name	:	ESTHER CURTIS
Credential	:
Telephone Number	:	509-619-0996

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	02/05/2012

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