=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407642978
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUSCLE MECHANIC MASSAGE THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2025
-----------------------------------------------------
Last Update Date | 04/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 212 S MAIN ST APT C
-----------------------------------------------------
City | COLFAX
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99111-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-828-3912
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 212 S MAIN ST APT C
-----------------------------------------------------
City | COLFAX
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99111-5003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-828-3912
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MASSAGE THERAPIST
-----------------------------------------------------
Name | BREANNE TUNISON
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 509-828-3912
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------