Provider Demographics
NPI:1942432638
Name:ELEMENTS THERAPEUTIC MASSAGE-VALLEY
Entity Type:Organization
Organization Name:ELEMENTS THERAPEUTIC MASSAGE-VALLEY
Other - Org Name:PAPA TONYS ENTERPRISES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER OF OPERSTIONS
Authorized Official - Prefix:
Authorized Official - First Name:FELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-928-9098
Mailing Address - Street 1:325 S SULLIVAN
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037
Mailing Address - Country:US
Mailing Address - Phone:509-928-9098
Mailing Address - Fax:509-315-8354
Practice Address - Street 1:325 S SULLIVAN
Practice Address - Street 2:SUITE B
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037
Practice Address - Country:US
Practice Address - Phone:509-928-9098
Practice Address - Fax:509-315-8354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty