=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417341272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | H&S NORTHWEST LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2015
-----------------------------------------------------
Last Update Date | 03/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10013 NE HAZEL DELL AVE SUITE 421
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98685-5203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-635-3496
-----------------------------------------------------
Fax | 360-546-0357
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10013 NE HAZEL DELL AVE SUITE 421
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98685-5203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-635-3496
-----------------------------------------------------
Fax | 360-546-0357
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | BRIAN KLINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-635-3496
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------