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General NPI Number Information
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NPI Number | 1457742280
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Entity Type | Organization
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Legal Business Name | ZENERGY MASSAGE CLINIC
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 1310 N I ST SUITE B
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City | TACOMA
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State | WA
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Zip | 98403
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Country | US
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Telephone | 253-572-9588
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 N I ST SUITE B
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City | TACOMA
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State | WA
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Zip | 98403
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Country | US
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Telephone | 253-572-9588
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LESA JEAN BOWLES
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Credential | LMP
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Telephone | 253-572-9588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | MA00019264
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License Number State | WA
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