Provider Demographics
NPI:1073808929
Name:SHANGRI-LA MASSAGE THERAPY
Entity type:Organization
Organization Name:SHANGRI-LA MASSAGE THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MUSTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-240-4206
Mailing Address - Street 1:7500 212TH ST SW STE 118
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7616
Mailing Address - Country:US
Mailing Address - Phone:206-240-4206
Mailing Address - Fax:425-245-5894
Practice Address - Street 1:7500 212TH ST SW STE 118
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7616
Practice Address - Country:US
Practice Address - Phone:206-240-4206
Practice Address - Fax:425-245-5894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024673225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty