Healthcare Provider Details

I. General information

NPI: 1487993325
Provider Name (Legal Business Name): SOUTHSOUND TREATMENT MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

818 39TH AVE SW STE A
PUYALLUP WA
98373-3308
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 Code225700000X
TaxonomyMassage Therapist
License Number60179153
License Number StateWA

VIII. Authorized Official

Name: MELISSA N BROWN
Title or Position: OWNER
Credential: LMP
Phone: 253-841-2200