MEDICARE: ROSEWATER HEALING ARTS AND 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	302F00000X	Exclusive Provider Organization	MA00018402	WA

General Provider Information

NPI Number	:	1881077261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEWATER HEALING ARTS AND MASSAGE

Provider Business Mailing Address
First Line	:	8552 MEADOWBROOK WAY SE
Second Line	:
City	:	SNOQUALMIE
State	:	WA
Zip	:	98065-9548
Country	:	US
Telephone Number	:	425-435-5838
Fax Number	:	866-462-2960

Provider Business Practice Location Address
First Line	:	213 BENDIGO BLVD N STE 3
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8259
Country	:	US
Telephone Number	:	425-435-5838
Fax Number	:	866-462-2960

Authorized Official
Title or Position	:	LMP
Name	:	MRS. SUSAN J BREWER
Credential	:	LMP
Telephone Number	:	425-435-5838

Provider Enumeration Date	:	07/03/2015
Last Update Date	:	07/03/2015

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