Provider Demographics
NPI:1376932004
Name:MONROE THERAPEUTIC MASSAGE, P.S.
Entity Type:Organization
Organization Name:MONROE THERAPEUTIC MASSAGE, P.S.
Other - Org Name:M3 BODYWORKS MASSAGE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-863-0642
Mailing Address - Street 1:101 E MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1519
Mailing Address - Country:US
Mailing Address - Phone:360-863-0642
Mailing Address - Fax:360-794-7236
Practice Address - Street 1:5236 CALIFORNIA AVE SW STE D
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1283
Practice Address - Country:US
Practice Address - Phone:206-331-3999
Practice Address - Fax:206-338-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty