Healthcare Provider Details

I. General information

NPI: 1326961533
Provider Name (Legal Business Name): MASON ROHDE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 INTELCO LOOP SE
OLYMPIA WA
98503-5941
US

IV. Provider business mailing address

4525 INTELCO LOOP SE
OLYMPIA WA
98503-5941
US

V. Phone/Fax

Practice location:
  • Phone: 360-489-2174
  • Fax: 360-923-9382
Mailing address:
  • Phone: 360-489-2174
  • Fax: 360-923-9382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.70142971
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: