Healthcare Provider Details

I. General information

NPI: 1164664991
Provider Name (Legal Business Name): ELEMENTS THERAPEUTIC MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E HASTINGS RD STE G
SPOKANE WA
99218-4901
US

IV. Provider business mailing address

101 E HASTINGS RD STE G
SPOKANE WA
99218-4901
US

V. Phone/Fax

Practice location:
  • Phone: 509-340-3303
  • Fax: 509-232-5550
Mailing address:
  • Phone: 509-340-3303
  • Fax: 509-232-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number602837572
License Number StateWA

VIII. Authorized Official

Name: STEVE SPARKS
Title or Position: OWNER
Credential:
Phone: 509-340-3303