Provider Demographics
NPI:1134492986
Name:UNDER THE INFLUENCE OF MASSAGE
Entity Type:Organization
Organization Name:UNDER THE INFLUENCE OF MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-573-3223
Mailing Address - Street 1:1612 NE 78TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9635
Mailing Address - Country:US
Mailing Address - Phone:360-573-3223
Mailing Address - Fax:
Practice Address - Street 1:1612 NE 78TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9635
Practice Address - Country:US
Practice Address - Phone:360-573-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNDER THE INFLUENCE OF MASSAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016071305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization