Healthcare Provider Details

I. General information

NPI: 1134655137
Provider Name (Legal Business Name): COMPETITIVE EDGE MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 200TH STREET CT E
SPANAWAY WA
98387-4770
US

IV. Provider business mailing address

5012 200TH STREET CT E
SPANAWAY WA
98387-4770
US

V. Phone/Fax

Practice location:
  • Phone: 253-905-6761
  • Fax:
Mailing address:
  • Phone: 253-905-6761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberMA00024666
License Number StateWA

VIII. Authorized Official

Name: MRS. CORALLEE ELIZABETH WEBER
Title or Position: LICENSED MASSAGE PRACTITIONER
Credential: LMP
Phone: 253-905-6761