Provider Demographics
NPI:1942746623
Name:SHIMMERING PALMS MASSAGE AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:SHIMMERING PALMS MASSAGE AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANYA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:509-954-9385
Mailing Address - Street 1:5218 W GARDEN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5324
Mailing Address - Country:US
Mailing Address - Phone:509-954-9385
Mailing Address - Fax:
Practice Address - Street 1:820 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2809
Practice Address - Country:US
Practice Address - Phone:509-954-9385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60716102225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty