Provider Demographics
NPI:1578933404
Name:APOLLONIAN LAUREL MASSAGE
Entity Type:Organization
Organization Name:APOLLONIAN LAUREL MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-328-0759
Mailing Address - Street 1:143 NE MIRAMAR CIR
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8502
Mailing Address - Country:US
Mailing Address - Phone:360-328-0759
Mailing Address - Fax:
Practice Address - Street 1:143 NE MIRAMAR CIR
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-8502
Practice Address - Country:US
Practice Address - Phone:360-328-0759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60513250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty