Provider Demographics
NPI:1144773938
Name:TRINITY MASSAGE CLINIC
Entity Type:Organization
Organization Name:TRINITY MASSAGE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:KARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:781-475-9647
Mailing Address - Street 1:1059 STATE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4269
Mailing Address - Country:US
Mailing Address - Phone:360-318-3476
Mailing Address - Fax:
Practice Address - Street 1:1059 STATE AVE STE D
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4269
Practice Address - Country:US
Practice Address - Phone:360-318-3476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60475800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty