Provider Demographics
NPI:1407136500
Name:WAL-INTEREST LLC
Entity Type:Organization
Organization Name:WAL-INTEREST LLC
Other - Org Name:ELEMENTS THERAPEUTIC MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-696-2000
Mailing Address - Street 1:3975 STATE HIGHWAY 6 S
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5895
Mailing Address - Country:US
Mailing Address - Phone:979-696-2000
Mailing Address - Fax:
Practice Address - Street 1:3975 STATE HIGHWAY 6 S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5895
Practice Address - Country:US
Practice Address - Phone:979-696-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty