MEDICARE: ELEMENTS THERAPEUTIC 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	602837572	WA

General Provider Information

NPI Number	:	1164664991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEMENTS THERAPEUTIC MASSAGE

Provider Business Mailing Address
First Line	:	101 E HASTINGS RD STE G
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-4901
Country	:	US
Telephone Number	:	509-340-3303
Fax Number	:	509-232-5550

Provider Business Practice Location Address
First Line	:	101 E HASTINGS RD STE G
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-4901
Country	:	US
Telephone Number	:	509-340-3303
Fax Number	:	509-232-5550

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE SPARKS
Credential	:
Telephone Number	:	509-340-3303

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	03/25/2009

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Directions to “ELEMENTS THERAPEUTIC MASSAGE ” Practice Location

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