Provider Demographics
NPI:1215194956
Name:AZZOPARDI, VIRGINIA (MASSAGE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:AZZOPARDI
Suffix:
Gender:F
Credentials:MASSAGE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:TRANQUIL WATERS MASSAGE THERAPY CLINIC
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-374-4719
Mailing Address - Fax:509-374-3873
Practice Address - Street 1:7101 WEST HOOD PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-374-4719
Practice Address - Fax:509-374-3873
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60002458225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist