Provider Demographics
NPI:1811019334
Name:MOUNTAIN SUN MASSAGE & SPA, INC
Entity Type:Organization
Organization Name:MOUNTAIN SUN MASSAGE & SPA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-825-0255
Mailing Address - Street 1:11930 SLATER AVE NE
Mailing Address - Street 2:#201
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4175
Mailing Address - Country:US
Mailing Address - Phone:425-825-0255
Mailing Address - Fax:425-821-8042
Practice Address - Street 1:11930 SLATER AVE NE
Practice Address - Street 2:#201
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4175
Practice Address - Country:US
Practice Address - Phone:425-825-0255
Practice Address - Fax:425-821-8042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty