MEDICARE: LIFESTYLES 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

General Provider Information

NPI Number	:	1386389518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLES MASSAGE

Provider Business Mailing Address
First Line	:	1468 OLNEY AVE SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-4078
Country	:	US
Telephone Number	:	360-443-2267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1468 OLNEY AVE SE
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-4078
Country	:	US
Telephone Number	:	360-443-2267
Fax Number	:

Authorized Official
Title or Position	:	OFFCIICE MANAGER
Name	:	KENNETH CHARLES SCHAFFER
Credential	:
Telephone Number	:	360-443-3226

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	05/02/2022

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Directions to “LIFESTYLES MASSAGE ” Practice Location

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