Provider Demographics
NPI:1568872893
Name:PREMIER MASSAGE STAFFING AGENCY, INC
Entity Type:Organization
Organization Name:PREMIER MASSAGE STAFFING AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR, LMP
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURDYSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-514-3122
Mailing Address - Street 1:15321 45TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8016
Mailing Address - Country:US
Mailing Address - Phone:253-514-3122
Mailing Address - Fax:253-857-4900
Practice Address - Street 1:15321 45TH AVE NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8016
Practice Address - Country:US
Practice Address - Phone:253-514-3122
Practice Address - Fax:253-857-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601697397225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1922230408OtherINSURANCE