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General NPI Number Information
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NPI Number | 1558072272
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Entity Type | Organization
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Legal Business Name | THE TEMPLE OF VENUS, OUR LADY OF LIGHT
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 983 STONE BROOK DR SW
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City | NORTH BEND
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State | WA
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Zip | 98045-9132
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Country | US
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Telephone | 425-428-9597
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Fax |
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Provider Business Mailing Address
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Address Line | 983 STONE BROOK DR SW
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City | NORTH BEND
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State | WA
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Zip | 98045-9132
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Country | US
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Telephone | 425-428-9597
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, ORDM
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Name | FRENCH SIGNY WALKER
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Credential | LMT, RYT
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Telephone | 425-428-9597
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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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