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NPI Code Detail

MEDICARE: EARTHBODY MASSAGE AND SPA

MEDICARE: EARTHBODY MASSAGE AND SPA
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
1174400000XSpecialist

General Provider Information

NPI Number : 1720662570
Entity Type Code : Organization
Provider Name (Legal Business Name) : EARTHBODY MASSAGE AND SPA
Provider Business Mailing Address
First Line : 11508 20TH ST SE
Second Line :
City : LAKE STEVENS
State : WA
Zip : 98258-4751
Country : US
Telephone Number : 425-345-1933
Fax Number : 360-547-6512
Provider Business Practice Location Address
First Line : 610 BEACH AVE STE 1
Second Line :
City : MARYSVILLE
State : WA
Zip : 98270-4571
Country : US
Telephone Number : 425-422-1558
Fax Number :
Authorized Official
Title or Position : OWNER
Name : LEAH KUYPER
Credential : LMT
Telephone Number : 425-345-1933
Provider Enumeration Date : 05/07/2021
Last Update Date : 04/27/2022

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Directions to “EARTHBODY MASSAGE AND SPA ” Practice Location

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