Provider Demographics
NPI:1790167971
Name:WELLNESS MASSAGE, LLC
Entity Type:Organization
Organization Name:WELLNESS MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-584-8031
Mailing Address - Street 1:100 RUBY ST SE STE F
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6724
Mailing Address - Country:US
Mailing Address - Phone:360-943-4797
Mailing Address - Fax:
Practice Address - Street 1:100 RUBY ST SE
Practice Address - Street 2:SUITE F
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6723
Practice Address - Country:US
Practice Address - Phone:360-943-4797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty