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General NPI Number Information
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NPI Number | 1497634794
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Entity Type | Organization
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Legal Business Name | SPOKANE MEDICAL MASSAGE PLLC
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 2020 E 29TH AVE STE 220
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City | SPOKANE
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State | WA
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Zip | 99203-3949
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Country | US
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Telephone | 509-879-1512
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Fax | 509-476-8676
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Provider Business Mailing Address
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Address Line | PO BOX 48002
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City | SPOKANE
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State | WA
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Zip | 99228-1002
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Country | US
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Telephone | 509-879-1512
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Fax | 509-467-8676
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Authorized Official
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Title or Position | OWNER
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Name | KYRA JEPPESEN
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Credential |
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Telephone | 509-879-1512
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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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