Provider Demographics
NPI:1396981411
Name:ADVANCED THERAPEUTIC MASSAGE OF WASHINGTON
Entity type:Organization
Organization Name:ADVANCED THERAPEUTIC MASSAGE OF WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-392-4700
Mailing Address - Street 1:4562 KLAHANIE DR SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5812
Mailing Address - Country:US
Mailing Address - Phone:425-392-4700
Mailing Address - Fax:
Practice Address - Street 1:4562 KLAHANIE DR SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-5812
Practice Address - Country:US
Practice Address - Phone:425-392-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00007233174400000X
WAMA 00012230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty