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General NPI Number Information
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NPI Number | 1649777137
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Entity Type | Organization
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Legal Business Name | URBAN ZEN PS
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 621 W MALLON AVE STE 609
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City | SPOKANE
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State | WA
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Zip | 99201-2164
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Country | US
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Telephone | 509-263-6099
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Fax |
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Provider Business Mailing Address
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Address Line | 1306 E GLENCREST DR
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City | SPOKANE
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State | WA
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Zip | 99208-9729
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JORDAN CROGAN
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Credential | MA60711330
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Telephone | 509-263-6099
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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 | 60711330
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License Number State | WA
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