Provider Demographics
NPI:1770979411
Name:SPARKS MASSAGE LLC-DBA ELEMENTS MASSSAGE
Entity type:Organization
Organization Name:SPARKS MASSAGE LLC-DBA ELEMENTS MASSSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ISIAH
Authorized Official - Middle Name:AARON DEAN
Authorized Official - Last Name:HOWARD-MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:509-710-5461
Mailing Address - Street 1:101 E HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-4901
Mailing Address - Country:US
Mailing Address - Phone:509-340-3303
Mailing Address - Fax:
Practice Address - Street 1:101 E. HASTINGS RD.
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218
Practice Address - Country:US
Practice Address - Phone:506-340-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60026751225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty