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General NPI Number Information
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NPI Number | 1700940525
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Entity Type | Organization
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Legal Business Name | HUDSBORNE ENTERPRISES, INC.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6108 NE HIGHWAY 99 STE 102
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City | VANCOUVER
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State | WA
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Zip | 98665-8751
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Country | US
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Telephone | 360-993-1320
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Fax | 360-993-5321
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Provider Business Mailing Address
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Address Line | 6400 NE HIGHWAY 99 STE G PMB 364
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City | VANCOUVER
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State | WA
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Zip | 98665-8748
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Country | US
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Telephone | 360-993-1320
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Fax | 360-993-5321
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PEGGY R. OSBORNE
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Credential | L.M.P.
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Telephone | 360-993-1320
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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 | MA06312 MA14678
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License Number State | WA
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