Provider Demographics
NPI:1467717314
Name:THE GOOD LIFE MASSAGE
Entity Type:Organization
Organization Name:THE GOOD LIFE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-737-7621
Mailing Address - Street 1:332 BURNETT AVE S
Mailing Address - Street 2:STE. M
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:332 BURNETT AVE S
Practice Address - Street 2:STE. M
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2505
Practice Address - Country:US
Practice Address - Phone:253-737-7621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60035114225700000X
WAMA 60252267225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty