=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043940109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARLINGTON MASSAGE THERAPY AND WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2022
-----------------------------------------------------
Last Update Date | 06/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18725 SMOKEY POINT BLVD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98223-8713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-657-4810
-----------------------------------------------------
Fax | 360-657-4817
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2999
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98223-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-657-4810
-----------------------------------------------------
Fax | 360-657-4817
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GAIL ANN ALLEN
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 360-657-4810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------