Healthcare Provider Details

I. General information

NPI: 1851643506
Provider Name (Legal Business Name): SNOHOMISH ACUPUNCTURE & MASSAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 7TH ST STE 2
SNOHOMISH WA
98290-2389
US

IV. Provider business mailing address

1400 7TH ST STE 2
SNOHOMISH WA
98290-2389
US

V. Phone/Fax

Practice location:
  • Phone: 360-563-5244
  • Fax:
Mailing address:
  • Phone: 360-563-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60208211
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA00014217
License Number StateWA

VIII. Authorized Official

Name: POLLY HEBERLE
Title or Position: ACUPUNCTURIST & MASSAGE THERAPIST
Credential: EAMP, LMP
Phone: 360-348-2717