Provider Demographics
NPI:1710364880
Name:THE MASSAGE AND BODYWORK COMPANY LLC
Entity Type:Organization
Organization Name:THE MASSAGE AND BODYWORK COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-445-6140
Mailing Address - Street 1:205 15TH AVE SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7873
Mailing Address - Country:US
Mailing Address - Phone:253-445-6140
Mailing Address - Fax:253-267-8060
Practice Address - Street 1:205 15TH AVE SW
Practice Address - Street 2:SUITE C
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7873
Practice Address - Country:US
Practice Address - Phone:253-445-6140
Practice Address - Fax:253-267-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019321305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization