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General NPI Number Information
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NPI Number | 1891113528
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Entity Type | Organization
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Legal Business Name | MONROE THERAPEUTIC MASSAGE, P.S.
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 21605 76TH AVE W
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City | EDMONDS
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State | WA
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Zip | 98026-7514
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Country | US
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Telephone | 425-814-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 11911 NE 132ND ST STE 101
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City | KIRKLAND
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State | WA
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Zip | 98034-2900
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Country | US
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Telephone | 425-814-8300
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Fax | 425-814-2004
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GLYN DESMOND
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Credential | LMP
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Telephone | 425-802-1382
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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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