Healthcare Provider Details

I. General information

NPI: 1982907796
Provider Name (Legal Business Name): PUGET SOUND MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11611 AIRPORT RD SUITE 204
EVERETT WA
98204-3782
US

IV. Provider business mailing address

PO BOX 663
MOUNTLAKE TERRACE WA
98043-0663
US

V. Phone/Fax

Practice location:
  • Phone: 425-348-4649
  • Fax: 425-348-0478
Mailing address:
  • Phone: 425-348-4649
  • 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: LEEANN BROWN
Title or Position: OWNER
Credential: LMP
Phone: 425-348-4649