Provider Demographics
NPI:1982248449
Name:THE MASSAGE STUDIO
Entity Type:Organization
Organization Name:THE MASSAGE STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:509-999-3733
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-0519
Mailing Address - Country:US
Mailing Address - Phone:509-999-3733
Mailing Address - Fax:
Practice Address - Street 1:613 S WASHINGTON ST STE 203
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2510
Practice Address - Country:US
Practice Address - Phone:509-315-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty