Provider Demographics
NPI:1013210137
Name:NATURAL REJUVENATION LLC
Entity Type:Organization
Organization Name:NATURAL REJUVENATION LLC
Other - Org Name:NATURAL REJUVENATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:D
Authorized Official - Last Name:RE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-590-6060
Mailing Address - Street 1:14700 E INDIANA AVE
Mailing Address - Street 2:SPACE 1092
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1839
Mailing Address - Country:US
Mailing Address - Phone:509-590-6060
Mailing Address - Fax:
Practice Address - Street 1:14700 E INDIANA AVE
Practice Address - Street 2:SPACE 1092
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1839
Practice Address - Country:US
Practice Address - Phone:509-590-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-11
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0002583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty