Healthcare Provider Details

I. General information

NPI: 1730620881
Provider Name (Legal Business Name): TONUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22520 SE 218TH ST
MAPLE VALLEY WA
98038-8001
US

IV. Provider business mailing address

18622 SE 265TH ST
COVINGTON WA
98042-8421
US

V. Phone/Fax

Practice location:
  • Phone: 206-755-1758
  • Fax: 253-883-2686
Mailing address:
  • Phone: 206-755-1758
  • Fax: 253-883-2686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60058598
License Number StateWA

VIII. Authorized Official

Name: MARIAM GEDEVANISHVILI
Title or Position: OWNER
Credential: LMP
Phone: 206-755-1758