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General NPI Number Information
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NPI Number | 1346368156
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Entity Type | Organization
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Legal Business Name | HERBAN OASIS
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 4611 N VISTA RD
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City | SPOKANE
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State | WA
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Zip | 99212-1728
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Country | US
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Telephone | 509-953-1121
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Fax | 509-928-5863
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Provider Business Mailing Address
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Address Line | 4611 N VISTA RD
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City | SPOKANE
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State | WA
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Zip | 99212-1728
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Country | US
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Telephone | 509-953-1121
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Fax | 509-928-5863
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Authorized Official
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Title or Position | OWNERPRESIDENT
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Name | DIANE YOUNG
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Credential | LMT
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Telephone | 509-953-1121
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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 | MA00007613
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License Number State | WA
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