Provider Demographics
NPI:1538421755
Name:A PUGET SOUND MASSAGE CLINIC, LLC
Entity type:Organization
Organization Name:A PUGET SOUND MASSAGE CLINIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-852-4853
Mailing Address - Street 1:5830 S MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-5326
Mailing Address - Country:US
Mailing Address - Phone:253-235-2440
Mailing Address - Fax:253-301-3057
Practice Address - Street 1:5830 S MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-5326
Practice Address - Country:US
Practice Address - Phone:253-235-2440
Practice Address - Fax:253-301-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60040591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty