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General NPI Number Information
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NPI Number | 1992017834
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Entity Type | Organization
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Legal Business Name | PAPA TONYS ENTERPRISE
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 07/08/2010
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Provider Practice Location Address
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Address Line | 325 S SULLIVAN RD
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037-6000
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Country | US
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Telephone | 509-928-9098
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Fax | 509-928-9091
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Provider Business Mailing Address
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Address Line | 325 S SULLIVAN RD
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037-6000
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Country | US
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Telephone | 509-928-9098
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Fax | 509-928-9091
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MRS. KRISTINA L PORTER
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Credential | LMP
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Telephone | 509-998-2786
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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 | MA60036541
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License Number State | WA
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