Provider Demographics
NPI:1487848685
Name:CEDAR RIVER MEDICAL MASAGE INC
Entity Type:Organization
Organization Name:CEDAR RIVER MEDICAL MASAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPAIRRING
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-793-7700
Mailing Address - Street 1:607 SW GRADY WAY STE 220
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2977
Mailing Address - Country:US
Mailing Address - Phone:425-793-7700
Mailing Address - Fax:
Practice Address - Street 1:607 SW GRADY WAY STE 220
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2977
Practice Address - Country:US
Practice Address - Phone:425-793-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty