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General NPI Number Information
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NPI Number | 1023653961
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Entity Type | Organization
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Legal Business Name | GENESIS MEDICAL SPA
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 504 GARFIELD ST S
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City | TACOMA
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State | WA
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Zip | 98444-3628
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Country | US
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Telephone | 253-886-3433
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Fax | 253-531-5917
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Provider Business Mailing Address
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Address Line | 504 GARFIELD ST S
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City | TACOMA
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State | WA
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Zip | 98444-3628
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Country | US
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Telephone | 253-886-3433
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | NIKITA D SCHIPPER
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Credential | LMP
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Telephone | 253-531-5917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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