Provider Demographics
NPI:1881411296
Name:EQUILIBRIUM MASSAGE & BODYWORK
Entity type:Organization
Organization Name:EQUILIBRIUM MASSAGE & BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EKATERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COSSER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:360-508-3665
Mailing Address - Street 1:2451 NE KRESKY AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2436
Mailing Address - Country:US
Mailing Address - Phone:360-508-3665
Mailing Address - Fax:
Practice Address - Street 1:2451 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2436
Practice Address - Country:US
Practice Address - Phone:360-508-3665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center