Healthcare Provider Details

I. General information

NPI: 1205192671
Provider Name (Legal Business Name): BLISSFUL MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3325 E. BRIDGEPORT AVE
SPOKANE WA
99217
US

IV. Provider business mailing address

3325 E. BRIDGEPORT AVENUE
SPOKANE WA
99217
US

V. Phone/Fax

Practice location:
  • Phone: 509-220-1323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberMA60258369
License Number StateWA

VIII. Authorized Official

Name: JOLENDA L FRY
Title or Position: LICENSED MASSAGE PRACTITIONER
Credential: L.M.P
Phone: 509-220-1323