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General NPI Number Information
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NPI Number | 1861639528
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Entity Type | Organization
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Legal Business Name | TOUCH OF GRACE MASSAGE AND WELL-SPA, LLC
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 1114 COURT E
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City | TACOMA
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State | WA
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Zip | 98402-2002
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Country | US
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Telephone | 253-241-0118
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Fax |
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Provider Business Mailing Address
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Address Line | 2522 N PROCTOR ST #507
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City | TACOMA
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State | WA
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Zip | 98406-5338
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Country | US
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Telephone | 253-241-0118
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Fax |
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Authorized Official
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Title or Position | MENBER1/MANAGER LLC
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Name | KIMBERLY RENEE PETERS-POONKASEM
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Credential | L.M.P.
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Telephone | 253-241-0118
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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 | MA60036366
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License Number State | WA
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