Provider Demographics
NPI:1679018691
Name:SUNSET MASSAGE
Entity Type:Organization
Organization Name:SUNSET MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MERA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:360-907-0627
Mailing Address - Street 1:819 SE 14TH LOOP
Mailing Address - Street 2:SUITE 101C
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4891
Mailing Address - Country:US
Mailing Address - Phone:360-907-0627
Mailing Address - Fax:
Practice Address - Street 1:819 SE 14TH LOOP
Practice Address - Street 2:SUITE 101C
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4891
Practice Address - Country:US
Practice Address - Phone:360-907-0627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020378225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty