Healthcare Provider Details

I. General information

NPI: 1497494355
Provider Name (Legal Business Name): EMBODIED WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6107 N ASTOR ST
SPOKANE WA
99208-8102
US

IV. Provider business mailing address

6107 N ASTOR ST
SPOKANE WA
99208-8102
US

V. Phone/Fax

Practice location:
  • Phone: 509-210-0550
  • Fax: 509-960-9003
Mailing address:
  • Phone: 509-968-1679
  • Fax: 509-960-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: NEREA KEESEE
Title or Position: ACUPUNCTURIST
Credential: L.AC., EAMP
Phone: 509-210-0550