Provider Demographics
NPI:1073892485
Name:THE MASSAGE & LASH IMAGE, LLC
Entity Type:Organization
Organization Name:THE MASSAGE & LASH IMAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMP
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-901-6711
Mailing Address - Street 1:3512 1/2 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3661
Mailing Address - Country:US
Mailing Address - Phone:509-248-2995
Mailing Address - Fax:
Practice Address - Street 1:3512 1/2 TIETON DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3661
Practice Address - Country:US
Practice Address - Phone:509-248-2995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60207041225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty