Healthcare Provider Details

I. General information

NPI: 1982017463
Provider Name (Legal Business Name): ELEMENTS MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E HASTINGS RD
SPOKANE WA
99218-4901
US

IV. Provider business mailing address

5114 N MAPLE ST
SPOKANE WA
99205-5526
US

V. Phone/Fax

Practice location:
  • Phone: 509-340-3303
  • Fax:
Mailing address:
  • Phone: 509-680-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberMA60471245
License Number StateWA

VIII. Authorized Official

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