Provider Demographics
NPI:1134655137
Name:COMPETITIVE EDGE MASSAGE
Entity Type:Organization
Organization Name:COMPETITIVE EDGE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORALLEE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-905-6761
Mailing Address - Street 1:5012 200TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-4770
Mailing Address - Country:US
Mailing Address - Phone:253-905-6761
Mailing Address - Fax:
Practice Address - Street 1:5012 200TH STREET CT E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-4770
Practice Address - Country:US
Practice Address - Phone:253-905-6761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024666251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health