Provider Demographics
NPI:1679956767
Name:HEALING TOUCH
Entity Type:Organization
Organization Name:HEALING TOUCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:M
Authorized Official - Last Name:POTRYASOV
Authorized Official - Suffix:
Authorized Official - Credentials:MA60290799
Authorized Official - Phone:360-931-8054
Mailing Address - Street 1:11300 NE FOURTH PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-5767
Mailing Address - Country:US
Mailing Address - Phone:360-931-8054
Mailing Address - Fax:360-433-9640
Practice Address - Street 1:11300 NE FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-5767
Practice Address - Country:US
Practice Address - Phone:360-931-8054
Practice Address - Fax:360-433-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60290799225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty