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General NPI Number Information
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NPI Number | 1639587306
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Entity Type | Organization
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Legal Business Name | HEAL YOUR WORLD MASSAGE THERAPY
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 2038 MCCLOUD CREEK RD
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City | NEWPORT
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State | WA
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Zip | 99156-8797
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Country | US
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Telephone | 509-671-0419
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Fax |
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Provider Business Mailing Address
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Address Line | 2038 MCCLOUD CREEK RD
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City | NEWPORT
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State | WA
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Zip | 99156-8797
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Country | US
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Telephone | 509-671-0419
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | MR. EDMOND D HEANEY
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Credential | LMT
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Telephone | 509-671-0419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | MA00013596
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License Number State | WA
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