Provider Demographics
NPI:1134504145
Name:BODY KNEADS MASSAGE THERAPY
Entity Type:Organization
Organization Name:BODY KNEADS MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMP OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUHRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA 00011423
Authorized Official - Phone:509-331-6308
Mailing Address - Street 1:445 CEDAR BLVD.
Mailing Address - Street 2:SUITE C
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344
Mailing Address - Country:US
Mailing Address - Phone:509-331-6308
Mailing Address - Fax:509-343-2762
Practice Address - Street 1:445 CEDAR BLVD.
Practice Address - Street 2:SUITE C
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344
Practice Address - Country:US
Practice Address - Phone:509-331-6308
Practice Address - Fax:509-343-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00011423305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization