Provider Demographics
NPI:1235551748
Name:STILLAGUAMISH MASSAGE THERAPY CLINIC
Entity Type:Organization
Organization Name:STILLAGUAMISH MASSAGE THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOP
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-474-1542
Mailing Address - Street 1:904 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1634
Mailing Address - Country:US
Mailing Address - Phone:360-474-1542
Mailing Address - Fax:360-474-1247
Practice Address - Street 1:904 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1634
Practice Address - Country:US
Practice Address - Phone:360-474-1542
Practice Address - Fax:360-474-1247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STILLAGUAMISHTRIBE OF INDIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty