Provider Demographics
NPI:1275924623
Name:PEARL PROFESSIONAL MASSAGE
Entity Type:Organization
Organization Name:PEARL PROFESSIONAL MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LMP, MMP
Authorized Official - Phone:253-230-2919
Mailing Address - Street 1:1919 N PEARL ST
Mailing Address - Street 2:A4
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2461
Mailing Address - Country:US
Mailing Address - Phone:253-761-0930
Mailing Address - Fax:253-761-8746
Practice Address - Street 1:1919 N PEARL ST
Practice Address - Street 2:A4
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2461
Practice Address - Country:US
Practice Address - Phone:253-761-0930
Practice Address - Fax:253-761-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018940174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty