Healthcare Provider Details

I. General information

NPI: 1629864319
Provider Name (Legal Business Name): CUPPING AND SPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 W 16TH AVE
KENNEWICK WA
99337-4733
US

IV. Provider business mailing address

16 W 16TH AVE
KENNEWICK WA
99337-4733
US

V. Phone/Fax

Practice location:
  • Phone: 509-607-2890
  • Fax:
Mailing address:
  • Phone: 509-607-2890
  • 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: LIDIYA RIVERA
Title or Position: OWNER
Credential: MASSAGE THERAPIST
Phone: 509-607-2890