Provider Demographics
NPI:1669670105
Name:THE MASSAGE CLINIC, INC.
Entity Type:Organization
Organization Name:THE MASSAGE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-258-5454
Mailing Address - Street 1:1515 PACIFIC AVE
Mailing Address - Street 2:B-1
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4001
Mailing Address - Country:US
Mailing Address - Phone:425-258-5454
Mailing Address - Fax:425-258-1967
Practice Address - Street 1:1515 PACIFIC AVE
Practice Address - Street 2:B-1
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4001
Practice Address - Country:US
Practice Address - Phone:425-258-5454
Practice Address - Fax:425-258-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011996225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty