Provider Demographics
NPI:1790988806
Name:SMOKEY POINT MASSAGE
Entity Type:Organization
Organization Name:SMOKEY POINT MASSAGE
Other - Org Name:GLENDA TAYLOR, LMP
Other - Org Type:Other Name
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-653-0950
Mailing Address - Street 1:16404 SMOKEY POINT BLVD
Mailing Address - Street 2:307
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8417
Mailing Address - Country:US
Mailing Address - Phone:360-653-0950
Mailing Address - Fax:360-653-9887
Practice Address - Street 1:16404 SMOKEY POINT BLVD
Practice Address - Street 2:307
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8417
Practice Address - Country:US
Practice Address - Phone:360-653-0950
Practice Address - Fax:360-653-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018548174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty