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General NPI Number Information
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NPI Number | 1205283413
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Entity Type | Organization
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Legal Business Name | NW LIFESTYLE MASSAGE & REIKI
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 1104 MAIN ST STE G50
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City | VANCOUVER
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State | WA
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Zip | 98660-2976
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Country | US
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Telephone | 360-975-0412
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 MAIN ST STE G50
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City | VANCOUVER
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State | WA
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Zip | 98660-2976
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Country | US
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Telephone | 360-975-0412
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Fax |
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Authorized Official
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Title or Position | L.M.P
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Name | RAYMOND KNUTSON
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Credential |
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Telephone | 360-975-0412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | MA60316991
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License Number State | WA
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