Provider Demographics
NPI:1508120510
Name:VALLEY MASSAGE CLINIC
Entity Type:Organization
Organization Name:VALLEY MASSAGE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTINGTALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:509-921-9800
Mailing Address - Street 1:12121 E BROADWAY AVE STE 5B
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4972
Mailing Address - Country:US
Mailing Address - Phone:509-921-9800
Mailing Address - Fax:509-921-9801
Practice Address - Street 1:2310 N MOLTER RD
Practice Address - Street 2:STE 108
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5036
Practice Address - Country:US
Practice Address - Phone:509-924-4443
Practice Address - Fax:509-924-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty