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General NPI Number Information
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NPI Number | 1710364880
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Entity Type | Organization
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Legal Business Name | THE MASSAGE AND BODYWORK COMPANY LLC
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 205 15TH AVE SW SUITE C
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City | PUYALLUP
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State | WA
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Zip | 98371-7873
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Country | US
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Telephone | 253-445-6140
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Fax | 253-267-8060
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Provider Business Mailing Address
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Address Line | 205 15TH AVE SW SUITE C
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City | PUYALLUP
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State | WA
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Zip | 98371-7873
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Country | US
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Telephone | 253-445-6140
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Fax | 253-267-8060
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Authorized Official
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Title or Position | OWNER/MASSAGE THERAPIST
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Name | MEGAN HOGLE
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Credential | LMP
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Telephone | 253-445-6140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | MA00019321
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License Number State | WA
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