Provider Demographics
NPI:1275995730
Name:ALIAGE S MASON LMP-C
Entity Type:Organization
Organization Name:ALIAGE S MASON LMP-C
Other - Org Name:CORE BALANCE YOGA MASSAGE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALIAGE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LMP-C
Authorized Official - Phone:509-969-8789
Mailing Address - Street 1:4110 TERRACE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1429
Mailing Address - Country:US
Mailing Address - Phone:509-969-8789
Mailing Address - Fax:509-344-1107
Practice Address - Street 1:4110 TERRACE HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1429
Practice Address - Country:US
Practice Address - Phone:509-969-8789
Practice Address - Fax:509-344-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012646225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty