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General NPI Number Information
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NPI Number | 1255581955
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Entity Type | Organization
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Legal Business Name | INTEGRATED THERAPIES, LLC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 22 TAHLEQUAH RD
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-9700
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Country | US
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Telephone | 360-379-1373
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 182
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City | PORT HADLOCK
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State | WA
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Zip | 98339-0182
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Country | US
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Telephone | 360-379-1373
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT MEMBER
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Name | MR. ANDREW MARTIN MUSSON
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Credential | LMP, CPT
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Telephone | 360-379-1373
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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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