Provider Demographics
NPI:1639587306
Name:HEAL YOUR WORLD MASSAGE THERAPY
Entity Type:Organization
Organization Name:HEAL YOUR WORLD MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEANEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:509-671-0419
Mailing Address - Street 1:2038 MCCLOUD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-8797
Mailing Address - Country:US
Mailing Address - Phone:509-671-0419
Mailing Address - Fax:
Practice Address - Street 1:2038 MCCLOUD CREEK RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-8797
Practice Address - Country:US
Practice Address - Phone:509-671-0419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013596320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0317768OtherL&I
WAMA00013596OtherMASSAGE PRACTITIONER LICENSE