MEDICARE: KITSAP MASSAGE THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist		WA

General Provider Information

NPI Number	:	1063692572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KITSAP MASSAGE THERAPY

Provider Business Mailing Address
First Line	:	2601 CHERRY AVE STE 100
Second Line	:
City	:	BREMERTON
State	:	WA
Zip	:	98310-4214
Country	:	US
Telephone Number	:	360-616-0487
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 CHERRY AVE STE 100
Second Line	:
City	:	BREMERTON
State	:	WA
Zip	:	98310-4214
Country	:	US
Telephone Number	:	360-616-0487
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	TRINA M BLOCK
Credential	:
Telephone Number	:	360-271-4123

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	11/13/2007

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Directions to “KITSAP MASSAGE THERAPY ” Practice Location

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