Provider Demographics
NPI:1417198656
Name:CHAPPAZ MASSAGE
Entity Type:Organization
Organization Name:CHAPPAZ MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:DALTON-RUBIDO
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-201-6276
Mailing Address - Street 1:1504 IOWA ST.
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229
Mailing Address - Country:US
Mailing Address - Phone:360-201-6276
Mailing Address - Fax:
Practice Address - Street 1:1504 IOWA ST.
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229
Practice Address - Country:US
Practice Address - Phone:360-201-6276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602779131225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0238744OtherL & I