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General NPI Number Information
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NPI Number | 1245487347
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Entity Type | Organization
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Legal Business Name | SOUTHSOUND TREATMENT MASSAGE
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 08/20/2008
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Provider Practice Location Address
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Address Line | 818 39TH AVE SW SUITE A
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City | PUYALLUP
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State | WA
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Zip | 98373-3308
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Country | US
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Telephone | 253-841-2200
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Fax | 253-848-1075
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Provider Business Mailing Address
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Address Line | PO BOX 731245
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City | PUYALLUP
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State | WA
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Zip | 98373-0060
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Country | US
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Telephone | 253-841-2200
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Fax | 253-848-1075
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Authorized Official
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Title or Position | OWNER
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Name | PEGGY SUE RESSEAU
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Credential | LMP
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Telephone | 253-841-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00009118
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License Number State | WA
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