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General NPI Number Information
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NPI Number | 1811873011
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Entity Type | Organization
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Legal Business Name | COASTLINE BODY AND MIND MASSAGE LLC
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 330 OCEAN DRIVE
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City | LA PUSH
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State | WA
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Zip | 98350
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Country | US
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Telephone | 360-640-9540
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 201
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City | LA PUSH
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State | WA
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Zip | 98350-0201
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Country | US
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Telephone | 360-640-9540
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | LETICIA JAIME
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Credential | L.M.T.
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Telephone | 360-640-9540
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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 |
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License Number State |
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