Healthcare Provider Details

I. General information

NPI: 1215194956
Provider Name (Legal Business Name): VIRGINIA AZZOPARDI MASSAGE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 WEST HOOD PLACE SUITE 102
KENNEWICK WA
99336
US

IV. Provider business mailing address

PO BOX 21 TRANQUIL WATERS MASSAGE THERAPY CLINIC
RICHLAND WA
99352
US

V. Phone/Fax

Practice location:
  • Phone: 509-374-4719
  • Fax: 509-374-3873
Mailing address:
  • Phone: 509-374-4719
  • Fax: 509-374-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60002458
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: