Provider Demographics
NPI:1417262106
Name:SUNRISE THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:SUNRISE THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-402-4792
Mailing Address - Street 1:20131 CHURCH LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8647
Mailing Address - Country:US
Mailing Address - Phone:360-402-4792
Mailing Address - Fax:253-447-7255
Practice Address - Street 1:11216 SUNRISE BLVD E
Practice Address - Street 2:SUITE #3-108
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8848
Practice Address - Country:US
Practice Address - Phone:253-604-0505
Practice Address - Fax:253-604-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017845225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty