Provider Demographics
NPI:1487220737
Name:FLOWSTATE BODYWORK
Entity Type:Organization
Organization Name:FLOWSTATE BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MAS
Authorized Official - Phone:253-677-9745
Mailing Address - Street 1:7216 NW IOKA DR
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7360
Mailing Address - Country:US
Mailing Address - Phone:253-677-9745
Mailing Address - Fax:
Practice Address - Street 1:1919 N PEARL ST STE B4
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2489
Practice Address - Country:US
Practice Address - Phone:253-677-9745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty