Provider Demographics
NPI:1295800399
Name:KNEADING HANDS MASSAGE THERAPY, LLC
Entity type:Organization
Organization Name:KNEADING HANDS MASSAGE THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ZYLSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-863-0960
Mailing Address - Street 1:17066 BEATON RD SE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1002
Mailing Address - Country:US
Mailing Address - Phone:360-863-0960
Mailing Address - Fax:360-863-8710
Practice Address - Street 1:17066 BEATON RD SE
Practice Address - Street 2:SUITE 170
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1002
Practice Address - Country:US
Practice Address - Phone:360-863-0960
Practice Address - Fax:360-863-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019954174400000X
WAMA00020051174400000X
WAMA00021601174400000X
WAMA00020587174400000X
WAMA00010802174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty