Healthcare Provider Details

I. General information

NPI: 1912451071
Provider Name (Legal Business Name): DCS THERAPEUTIC MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2016
Last Update Date: 08/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S 11TH AVE
YAKIMA WA
98902-3213
US

IV. Provider business mailing address

319 S 11TH AVE
YAKIMA WA
98902-3213
US

V. Phone/Fax

Practice location:
  • Phone: 509-453-1420
  • Fax: 509-453-1453
Mailing address:
  • Phone: 509-453-1420
  • Fax: 509-453-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00020706
License Number StateWA

VIII. Authorized Official

Name: DANIELLE N STEVENS
Title or Position: LMP
Credential:
Phone: 509-453-1420