MEDICARE: ESSENTIAL MASSAGE

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	MA00021616	WA

General Provider Information

NPI Number	:	1144591447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL MASSAGE

Provider Business Mailing Address
First Line	:	421 W RIVERSIDE AVE STE 614
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0402
Country	:	US
Telephone Number	:	509-474-1885
Fax Number	:	509-474-9756

Provider Business Practice Location Address
First Line	:	421 W RIVERSIDE AVE STE 614
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0402
Country	:	US
Telephone Number	:	509-474-1885
Fax Number	:	509-474-9756

Authorized Official
Title or Position	:	LMP/OWNER
Name	:	CASSIE MICHELE BAKER
Credential	:	LMP
Telephone Number	:	509-474-1885

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	09/21/2012

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Directions to “ESSENTIAL MASSAGE ” Practice Location

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