Provider Demographics
NPI:1164725792
Name:KITSAP PRACTICE MANAGEMENT, INC.
Entity Type:Organization
Organization Name:KITSAP PRACTICE MANAGEMENT, INC.
Other - Org Name:NW THERAPEUTIC MASSAGE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:GEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-692-7321
Mailing Address - Street 1:9889 CENTRAL VALLEY RD NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-9131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9414 RIDGETOP BLVD NW
Practice Address - Street 2:SUITE 103
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8525
Practice Address - Country:US
Practice Address - Phone:360-307-7227
Practice Address - Fax:360-307-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty