Healthcare Provider Details

I. General information

NPI: 1164351516
Provider Name (Legal Business Name): NEIL NEYRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 S 324TH ST STE B115
FEDERAL WAY WA
98003-8486
US

IV. Provider business mailing address

25616 LAKE FENWICK RD
KENT WA
98032-4275
US

V. Phone/Fax

Practice location:
  • Phone: 253-638-2424
  • Fax: 253-639-5115
Mailing address:
  • Phone: 702-672-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70125799
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: