Provider Demographics
NPI:1891175808
Name:MUSCLE RELEASE MEDICAL MASSAGE, LLC
Entity Type:Organization
Organization Name:MUSCLE RELEASE MEDICAL MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMP, CMMP
Authorized Official - Phone:509-952-5399
Mailing Address - Street 1:3908 CREEKSIDE LOOP STE 110
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4858
Mailing Address - Country:US
Mailing Address - Phone:509-952-5399
Mailing Address - Fax:509-248-5356
Practice Address - Street 1:3908 CREEKSIDE LOOP STE 110
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4858
Practice Address - Country:US
Practice Address - Phone:509-952-5399
Practice Address - Fax:509-248-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021915225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty