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General NPI Number Information
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NPI Number | 1538421755
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Entity Type | Organization
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Legal Business Name | A PUGET SOUND MASSAGE CLINIC, LLC
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 5830 S MONTGOMERY ST
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City | TACOMA
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State | WA
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Zip | 98409-5326
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Country | US
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Telephone | 253-235-2440
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Fax | 253-301-3057
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Provider Business Mailing Address
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Address Line | 5830 S MONTGOMERY ST
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City | TACOMA
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State | WA
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Zip | 98409-5326
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Country | US
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Telephone | 253-235-2440
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Fax | 253-301-3057
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Authorized Official
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Title or Position | OWNER
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Name | PAULA JEAN SNOW
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Credential | LMP
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Telephone | 206-852-4853
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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 | MA60040591
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License Number State | WA
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