Healthcare Provider Details

I. General information

NPI: 1306761853
Provider Name (Legal Business Name): MORTONS MASSAGE AT EVERGREEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27641 COVINGTON WAY SE STE 1
COVINGTON WA
98042-9120
US

IV. Provider business mailing address

20007 RHODODENDRON DR E
BONNEY LAKE WA
98391-7799
US

V. Phone/Fax

Practice location:
  • Phone: 253-880-7827
  • Fax:
Mailing address:
  • Phone: 253-880-7827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHANNON L MORTON
Title or Position: OWNER
Credential: LMT
Phone: 253-880-7827