Provider Demographics
NPI:1841526233
Name:MOUNTAIN SUN MASSAGE & SKIN CARE, LLC
Entity type:Organization
Organization Name:MOUNTAIN SUN MASSAGE & SKIN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-825-0255
Mailing Address - Street 1:11930 SLATER AVE NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4175
Mailing Address - Country:US
Mailing Address - Phone:425-825-0255
Mailing Address - Fax:425-821-8042
Practice Address - Street 1:11930 SLATER AVE NE
Practice Address - Street 2:SUITE 201
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4175
Practice Address - Country:US
Practice Address - Phone:425-825-0255
Practice Address - Fax:425-821-8042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602961520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty