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General NPI Number Information
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NPI Number | 1467717314
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Entity Type | Organization
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Legal Business Name | THE GOOD LIFE MASSAGE
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 332 BURNETT AVE S STE. M
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City | RENTON
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State | WA
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Zip | 98057-2505
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Country | US
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Telephone | 253-737-7621
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Fax |
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Provider Business Mailing Address
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Address Line | 332 BURNETT AVE S STE. M
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City | RENTON
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State | WA
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Zip | 98057-2505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | KRISTINE SCOTT
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Credential |
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Telephone | 253-737-7621
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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 | MA 60252267
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 60035114
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License Number State | WA
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