Provider Demographics
NPI:1467990788
Name:SANDPOINT MEDICAL MASSAGE AND BODYWORKS
Entity Type:Organization
Organization Name:SANDPOINT MEDICAL MASSAGE AND BODYWORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-369-8652
Mailing Address - Street 1:515 PINE ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1640
Mailing Address - Country:US
Mailing Address - Phone:208-502-0728
Mailing Address - Fax:208-575-8309
Practice Address - Street 1:515 PINE ST
Practice Address - Street 2:SUITE G
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1640
Practice Address - Country:US
Practice Address - Phone:208-502-0728
Practice Address - Fax:208-575-8309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS-2400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty