Healthcare Provider Details

I. General information

NPI: 1356576714
Provider Name (Legal Business Name): ESCAPE 2 MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S. WARREN ST UNIT D
ROY WA
98580
US

IV. Provider business mailing address

PO BOX 251
ROY WA
98580-0251
US

V. Phone/Fax

Practice location:
  • Phone: 253-843-1182
  • Fax:
Mailing address:
  • Phone: 253-843-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00021061
License Number StateWA

VIII. Authorized Official

Name: DANA CORINNE HILL
Title or Position: MASSAGE THERAPIST
Credential:
Phone: 253-843-1182