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General NPI Number Information
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NPI Number | 1558501767
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Entity Type | Organization
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Legal Business Name | WINTER ROSE BODY THERAPY INC
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 422 CARPENTER RD SE SUITE 104
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City | LACEY
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State | WA
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Zip | 98503-7906
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Country | US
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Telephone | 360-459-7673
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Fax | 866-880-4246
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Provider Business Mailing Address
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Address Line | 422 CARPENTER RD SE SUITE 104
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City | LACEY
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State | WA
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Zip | 98503-7906
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Country | US
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Telephone | 360-459-7673
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Fax | 866-880-4246
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Authorized Official
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Title or Position | OWNER/OPPERATOR
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Name | MRS. APRIL ROSE GAYDOS
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Credential | LMP
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Telephone | 360-459-7673
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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 | MA00020229
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License Number State | WA
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