MEDICARE: MAHAL BODYWORK STUDIO, LLC

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

General Provider Information

NPI Number	:	1235919101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHAL BODYWORK STUDIO, LLC

Provider Business Mailing Address
First Line	:	2307 HENRY ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-2208
Country	:	US
Telephone Number	:	415-465-2401
Fax Number	:	206-826-6399

Provider Business Practice Location Address
First Line	:	1200 HARRIS AVE STE 405
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-7146
Country	:	US
Telephone Number	:	415-465-2401
Fax Number	:	206-826-6399

Authorized Official
Title or Position	:	LMT
Name	:	MS. MARIE GRACE DUFRESNE
Credential	:	MA, CHT, LMT
Telephone Number	:	415-465-2401

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	01/30/2026

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