Healthcare Provider Details

I. General information

NPI: 1346990785
Provider Name (Legal Business Name): INNER WISDOM BODYWORK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 BETHEL RD. SE SUITE 110
PORT ORCHARD WA
98366
US

IV. Provider business mailing address

340 TREMONT ST
PORT ORCHARD WA
98366-3734
US

V. Phone/Fax

Practice location:
  • Phone: 360-443-6508
  • Fax: 360-397-0364
Mailing address:
  • Phone: 360-990-8877
  • Fax: 360-397-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA GALLEGOS-WHITE
Title or Position: OWNER
Credential: LAC., LMT
Phone: 360-990-8877