=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215650155
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE MASI LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2022
-----------------------------------------------------
Last Update Date | 09/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3710 168TH ST NE STE B102
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98223-8463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-631-9965
-----------------------------------------------------
Fax | 360-322-6606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3710 168TH ST NE STE B102
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98223-8463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-631-9965
-----------------------------------------------------
Fax | 360-322-6606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA60502159
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------