=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447141494
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUPINE PEAK WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2025
-----------------------------------------------------
Last Update Date | 07/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4803 84TH ST SW
-----------------------------------------------------
City | MUKILTEO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98275-3023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-490-7472
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11601 HARBOUR POINTE BLVD #17 STE 103
-----------------------------------------------------
City | MUKILTEO
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98275-5262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-490-7472
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ MANAGER
-----------------------------------------------------
Name | MS. CATHERINE J HAWKINS
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 425-490-7472
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------