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General NPI Number Information
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NPI Number | 1386314169
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Entity Type | Organization
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Legal Business Name | SANCTUARY MASSAGE AND WELLNESS PLLC
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 06/24/2023
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Provider Practice Location Address
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Address Line | 601 MAIN ST STE 209
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City | VANCOUVER
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State | WA
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Zip | 98660-3403
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Country | US
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Telephone | 360-558-8166
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Fax |
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Provider Business Mailing Address
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Address Line | 1124 N 1ST AVE
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City | KELSO
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State | WA
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Zip | 98626-3600
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Country | US
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Telephone | 360-558-8166
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | ELIZABETH DEARMIN
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Credential | LMT
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Telephone | 360-558-8166
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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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