Healthcare Provider Details

I. General information

NPI: 1245487347
Provider Name (Legal Business Name): SOUTHSOUND TREATMENT MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 39TH AVE SW SUITE A
PUYALLUP WA
98373-3308
US

IV. Provider business mailing address

PO BOX 731245
PUYALLUP WA
98373-0060
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-2200
  • Fax: 253-848-1075
Mailing address:
  • Phone: 253-841-2200
  • Fax: 253-848-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00009118
License Number StateWA

VIII. Authorized Official

Name: PEGGY SUE RESSEAU
Title or Position: OWNER
Credential: LMP
Phone: 253-841-2200