Provider Demographics
NPI:1447579362
Name:BALANCED BODY MASSAGE, LLC
Entity Type:Organization
Organization Name:BALANCED BODY MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MARCELLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-970-0433
Mailing Address - Street 1:10909 PORTLAND AVE E
Mailing Address - Street 2:SUITE F
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-5252
Mailing Address - Country:US
Mailing Address - Phone:253-970-0433
Mailing Address - Fax:
Practice Address - Street 1:10909 PORTLAND AVE E
Practice Address - Street 2:SUITE F
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-5252
Practice Address - Country:US
Practice Address - Phone:253-970-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty