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General NPI Number Information
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NPI Number | 1376085472
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Entity Type | Organization
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Legal Business Name | RESTORE MASSAGE THERAPY AND HEALING ARTS, PLLC
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Dates
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Enumeration Date | 11/07/2016
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 800 FRANKLIN ST SUITE 200
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City | VANCOUVER
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State | WA
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Zip | 98660-3355
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Country | US
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Telephone | 541-429-0408
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Fax |
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Provider Business Mailing Address
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Address Line | 700 WASHINGTON ST APT 925
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City | VANCOUVER
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State | WA
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Zip | 98660-3177
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Country | US
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Telephone | 541-429-0408
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY KRISTINE HOUGER
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Credential | LMT
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Telephone | 541-429-0408
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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 | MA60696037
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License Number State | WA
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