Healthcare Provider Details

I. General information

NPI: 1447579362
Provider Name (Legal Business Name): BALANCED BODY MASSAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10909 PORTLAND AVE E SUITE F
TACOMA WA
98445-5252
US

IV. Provider business mailing address

10909 PORTLAND AVE E SUITE F
TACOMA WA
98445-5252
US

V. Phone/Fax

Practice location:
  • Phone: 253-970-0433
  • Fax:
Mailing address:
  • Phone: 253-970-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHANIE RENEE MARCELLE
Title or Position: MANAGING MEMBER
Credential: LMP
Phone: 253-970-0433