Provider Demographics
NPI:1396454336
Name:MIND BODY SPIRIT MASSAGE, ELLIE ESTEVES LMP LLC
Entity type:Organization
Organization Name:MIND BODY SPIRIT MASSAGE, ELLIE ESTEVES LMP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ELIANNETTE
Authorized Official - Middle Name:ENID
Authorized Official - Last Name:ESTEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-431-4437
Mailing Address - Street 1:6019 ALAMEDA AVE W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-2818
Mailing Address - Country:US
Mailing Address - Phone:253-431-4437
Mailing Address - Fax:253-262-0591
Practice Address - Street 1:4308 N 26TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-5211
Practice Address - Country:US
Practice Address - Phone:253-431-4437
Practice Address - Fax:253-262-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty