Provider Demographics
NPI:1083040034
Name:ARN'S THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:ARN'S THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMP
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARN
Authorized Official - Suffix:
Authorized Official - Credentials:MA00023548
Authorized Official - Phone:360-521-0804
Mailing Address - Street 1:1913 NW 7TH CT
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-6805
Mailing Address - Country:US
Mailing Address - Phone:360-521-0804
Mailing Address - Fax:360-891-8000
Practice Address - Street 1:5501 NE 109TH CT
Practice Address - Street 2:SUITE L
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6177
Practice Address - Country:US
Practice Address - Phone:360-521-0804
Practice Address - Fax:360-891-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023548225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1033443007OtherNPI TYPE 1