Provider Demographics
NPI:1629664727
Name:RIDGEFIELD THERAPEUTIC MASSAGE LLC
Entity Type:Organization
Organization Name:RIDGEFIELD THERAPEUTIC MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER LMT
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:509-981-0801
Mailing Address - Street 1:4593 N NOBLE LOOP
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-7858
Mailing Address - Country:US
Mailing Address - Phone:509-981-0801
Mailing Address - Fax:
Practice Address - Street 1:255 S 47TH AVE STE 125
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-7781
Practice Address - Country:US
Practice Address - Phone:509-981-0801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty