Provider Demographics
NPI:1245655513
Name:NEW LEAF MASSAGE, LLC
Entity type:Organization
Organization Name:NEW LEAF MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:REDINBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-514-3636
Mailing Address - Street 1:8730 TALLON LN NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-6609
Mailing Address - Country:US
Mailing Address - Phone:253-514-3636
Mailing Address - Fax:
Practice Address - Street 1:8730 TALLON LN NE
Practice Address - Street 2:SUITE 104
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6609
Practice Address - Country:US
Practice Address - Phone:253-514-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty