Provider Demographics
NPI:1588802656
Name:HAZEL DELL THERAPEUTIC MASSAGE
Entity Type:Organization
Organization Name:HAZEL DELL THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THREAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZARZANA
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-695-6055
Mailing Address - Street 1:6202 NE HIGHWAY 99 STE 4
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8747
Mailing Address - Country:US
Mailing Address - Phone:360-695-6055
Mailing Address - Fax:360-735-7628
Practice Address - Street 1:6202 NE HIGHWAY 99 STE 4
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8747
Practice Address - Country:US
Practice Address - Phone:360-695-6055
Practice Address - Fax:360-735-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019181261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service