Provider Demographics
NPI:1346965043
Name:FLOURISHLMT PLLC
Entity Type:Organization
Organization Name:FLOURISHLMT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESTYNE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:360-334-6373
Mailing Address - Street 1:8221 NE HAZEL DELL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8153
Mailing Address - Country:US
Mailing Address - Phone:360-334-6373
Mailing Address - Fax:360-583-3559
Practice Address - Street 1:8221 NE HAZEL DELL AVE STE 104
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8153
Practice Address - Country:US
Practice Address - Phone:360-334-6373
Practice Address - Fax:360-583-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11045879554OtherNPI