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General NPI Number Information
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NPI Number | 1174407720
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Entity Type | Organization
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Legal Business Name | THETA ENTERPRISES LLC
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 202 W MAIN ST
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City | MONROE
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State | WA
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Zip | 98272-1819
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Country | US
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Telephone | 425-780-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 19504 66TH AVE W
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City | LYNNWOOD
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State | WA
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Zip | 98036-5163
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Country | US
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Telephone | 206-853-9133
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVE RODRIGUEZ
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Credential |
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Telephone | 206-853-9133
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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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