Healthcare Provider Details

I. General information

NPI: 1295597599
Provider Name (Legal Business Name): BELLA TERRA MASSAGE & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 W STEWART
PUYALLUP WA
98371-5149
US

IV. Provider business mailing address

1503 W STEWART
PUYALLUP WA
98371-5149
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-6844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA ANTONGIOVANNI
Title or Position: DIRECTOR
Credential: LMT
Phone: 253-848-6844