Provider Demographics
NPI:1447588108
Name:PLATEAU MASSAGE LLC
Entity Type:Organization
Organization Name:PLATEAU MASSAGE LLC
Other - Org Name:PLATEAU MASSAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:CMA, LMP
Authorized Official - Phone:253-261-8167
Mailing Address - Street 1:2820 GRIFFIN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2373
Mailing Address - Country:US
Mailing Address - Phone:253-261-8167
Mailing Address - Fax:360-825-9255
Practice Address - Street 1:2820 GRIFFIN AVE STE 204
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2373
Practice Address - Country:US
Practice Address - Phone:253-261-8167
Practice Address - Fax:360-825-9255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60117448225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty