Healthcare Provider Details

I. General information

NPI: 1801274543
Provider Name (Legal Business Name): OLYMPUS SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8615 S TACOMA WAY
LAKEWOOD WA
98499-4542
US

IV. Provider business mailing address

8615 S TACOMA WAY
LAKEWOOD WA
98499-4542
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-3355
  • Fax: 253-588-3367
Mailing address:
  • Phone: 253-588-3355
  • Fax: 253-588-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60533053
License Number StateWA

VIII. Authorized Official

Name: TALITHA ANN EUSTICE
Title or Position: LICENSED MASSAGE PRACTITIONER
Credential:
Phone: 469-554-9642