MEDICARE: 3-CITIES ON-SITE MASSAGE, INC.

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	MA00009154	WA

General Provider Information

NPI Number	:	1174733810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3-CITIES ON-SITE MASSAGE, INC.

Provider Business Mailing Address
First Line	:	3902 W CLEARWATER AVE
Second Line	:	SUITE 114
City	:	KENNEWICK
State	:	WA
Zip	:	99336-2676
Country	:	US
Telephone Number	:	509-783-0924
Fax Number	:

Provider Business Practice Location Address
First Line	:	3902 W CLEARWATER AVE
Second Line	:	SUITE 114
City	:	KENNEWICK
State	:	WA
Zip	:	99336-2678
Country	:	US
Telephone Number	:	509-783-0924
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SUSANNE M STEEL
Credential	:	L.M.P.
Telephone Number	:	509-783-0924

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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