=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932766680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE GOOD LIFE MASSAGE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2019
-----------------------------------------------------
Last Update Date | 04/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 S TOBIN ST STE A
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-5338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-243-7705
-----------------------------------------------------
Fax | 425-321-5508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 S TOBIN ST STE A
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-5338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-243-7705
-----------------------------------------------------
Fax | 425-321-5508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE/BILLING MANAGER
-----------------------------------------------------
Name | TERESA MAE ARAUCTO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 425-243-7705
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------