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General NPI Number Information
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NPI Number | 1659778645
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Entity Type | Organization
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Legal Business Name | YOUR RELAXATION MASSAGE
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 22811 MERIDIAN AVE E UNIT A
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City | GRAHAM
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State | WA
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Zip | 98338-9275
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Country | US
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Telephone | 253-271-9351
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Fax |
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Provider Business Mailing Address
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Address Line | 7814 266TH ST E
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City | GRAHAM
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State | WA
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Zip | 98338-7308
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Country | US
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Telephone | 253-271-9351
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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 | MRS. SARA MICHELE ALLEN
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Credential |
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Telephone | 253-271-9351
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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 | MA60484352
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License Number State | WA
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