Provider Demographics
NPI:1457483216
Name:MYOPATHIC MUSCULAR THERAPY CLINIC, INC.
Entity Type:Organization
Organization Name:MYOPATHIC MUSCULAR THERAPY CLINIC, INC.
Other - Org Name:MYOPATHIC MUSCULAR THERAPY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:OSMARINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-712-0852
Mailing Address - Street 1:4610 200TH ST SW
Mailing Address - Street 2:SUITE # N
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6606
Mailing Address - Country:US
Mailing Address - Phone:425-712-0852
Mailing Address - Fax:425-712-0854
Practice Address - Street 1:4610 200TH ST SW
Practice Address - Street 2:SUITE # N
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6606
Practice Address - Country:US
Practice Address - Phone:425-712-0852
Practice Address - Fax:425-712-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty