Provider Demographics
NPI:1376085472
Name:RESTORE MASSAGE THERAPY AND HEALING ARTS, PLLC
Entity Type:Organization
Organization Name:RESTORE MASSAGE THERAPY AND HEALING ARTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:HOUGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-429-0408
Mailing Address - Street 1:700 WASHINGTON ST
Mailing Address - Street 2:APT 925
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3177
Mailing Address - Country:US
Mailing Address - Phone:541-429-0408
Mailing Address - Fax:
Practice Address - Street 1:800 FRANKLIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3355
Practice Address - Country:US
Practice Address - Phone:541-429-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60696037225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty