Provider Demographics
NPI:1225575681
Name:SPOKANE WELLNESS MASSAGE, LLC
Entity Type:Organization
Organization Name:SPOKANE WELLNESS MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPEAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:509-953-4149
Mailing Address - Street 1:2426 S DISHMAN MICA RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6409
Mailing Address - Country:US
Mailing Address - Phone:509-953-4149
Mailing Address - Fax:
Practice Address - Street 1:2426 S DISHMAN MICA RD STE 3
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6409
Practice Address - Country:US
Practice Address - Phone:509-953-4149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00010161225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty