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General NPI Number Information
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NPI Number | 1720329303
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Entity Type | Organization
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Legal Business Name | ONE BODY MASSAGE & RESTORATION LLC
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 1106 HARRIS AVE. #312
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City | BELLINGHAM
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State | WA
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Zip | 98225
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Country | US
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Telephone | 360-223-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 HARRIS AVE. #312
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City | BELLINGHAM
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State | WA
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Zip | 98225
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Country | US
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Telephone | 360-223-0001
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Fax |
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Authorized Official
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Title or Position | OWNER / OPERATOR
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Name | MRS. CORENIA MURPHY
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Credential | LMP
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Telephone | 360-223-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA60173639
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License Number State | WA
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