MEDICARE: THE TEMPLE OF VENUS, OUR LADY OF LIGHT

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	:	1558072272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE TEMPLE OF VENUS, OUR LADY OF LIGHT

Provider Business Mailing Address
First Line	:	983 STONE BROOK DR SW
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-9132
Country	:	US
Telephone Number	:	425-428-9597
Fax Number	:

Provider Business Practice Location Address
First Line	:	983 STONE BROOK DR SW
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-9132
Country	:	US
Telephone Number	:	425-428-9597
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, ORDM
Name	:	FRENCH SIGNY WALKER
Credential	:	LMT, RYT
Telephone Number	:	425-428-9597

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	12/13/2022

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