Provider Demographics
NPI:1134465628
Name:MASSAGEWORKS
Entity Type:Organization
Organization Name:MASSAGEWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE PRACTIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MENDHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-381-6700
Mailing Address - Street 1:PO BOX 731146
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0049
Mailing Address - Country:US
Mailing Address - Phone:253-381-6700
Mailing Address - Fax:253-841-1345
Practice Address - Street 1:14001 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5618
Practice Address - Country:US
Practice Address - Phone:253-381-6700
Practice Address - Fax:253-841-1345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020495225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty