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General NPI Number Information
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NPI Number | 1720662570
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Entity Type | Organization
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Legal Business Name | EARTHBODY MASSAGE AND SPA
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Dates
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Enumeration Date | 05/07/2021
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 610 BEACH AVE STE 1
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City | MARYSVILLE
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State | WA
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Zip | 98270-4571
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Country | US
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Telephone | 425-422-1558
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Fax |
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Provider Business Mailing Address
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Address Line | 11508 20TH ST SE
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City | LAKE STEVENS
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State | WA
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Zip | 98258-4751
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Country | US
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Telephone | 425-345-1933
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Fax | 360-547-6512
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Authorized Official
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Title or Position | OWNER
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Name | LEAH KUYPER
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Credential | LMT
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Telephone | 425-345-1933
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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 |
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License Number State |
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