Provider Demographics
NPI:1649441031
Name:THE NW MASSAGE CENTER, LLC
Entity type:Organization
Organization Name:THE NW MASSAGE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:IDA
Authorized Official - Last Name:FORGEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-927-9382
Mailing Address - Street 1:32015 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5701
Mailing Address - Country:US
Mailing Address - Phone:253-927-9382
Mailing Address - Fax:253-661-3284
Practice Address - Street 1:6716 E SIDE DR NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1147
Practice Address - Country:US
Practice Address - Phone:253-927-9382
Practice Address - Fax:253-661-3284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty