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General NPI Number Information
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NPI Number | 1417262106
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Entity Type | Organization
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Legal Business Name | SUNRISE THERAPEUTIC MASSAGE
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 08/18/2010
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Provider Practice Location Address
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Address Line | 11216 SUNRISE BLVD E SUITE #3-108
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City | PUYALLUP
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State | WA
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Zip | 98374-8848
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Country | US
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Telephone | 253-604-0505
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Fax | 253-604-0506
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Provider Business Mailing Address
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Address Line | 20131 CHURCH LAKE DR E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-8647
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Country | US
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Telephone | 360-402-4792
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Fax | 253-447-7255
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Authorized Official
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Title or Position | OWNER/MANAGING MEMBER
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Name | JONI ALLEN
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Credential | LMP
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Telephone | 360-402-4792
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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 | MA00017845
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License Number State | WA
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