Provider Demographics
NPI:1013451079
Name:DECIDE MASSAGE & WELLNESS
Entity Type:Organization
Organization Name:DECIDE MASSAGE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-354-8382
Mailing Address - Street 1:3823 SHORE AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1228
Mailing Address - Country:US
Mailing Address - Phone:206-354-8382
Mailing Address - Fax:
Practice Address - Street 1:7104 265TH ST NW STE 130
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-6250
Practice Address - Country:US
Practice Address - Phone:206-354-8382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-10
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60708337302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization