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General NPI Number Information
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NPI Number | 1487220737
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Entity Type | Organization
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Legal Business Name | FLOWSTATE BODYWORK
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 1919 N PEARL ST STE B4
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City | TACOMA
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State | WA
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Zip | 98406-2489
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Country | US
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Telephone | 253-677-9745
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Fax |
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Provider Business Mailing Address
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Address Line | 7216 NW IOKA DR
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City | SILVERDALE
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State | WA
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Zip | 98383-7360
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Country | US
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Telephone | 253-677-9745
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | KELLEY JOHNSON
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Credential | MAS
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Telephone | 253-677-9745
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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 |
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License Number State |
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