Provider Demographics
NPI:1063752442
Name:PERRIGO MASSAGE LLC
Entity type:Organization
Organization Name:PERRIGO MASSAGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NARILYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PERRIGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-217-6281
Mailing Address - Street 1:12932 SE KENT KANGLEY RD # 348
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7940
Mailing Address - Country:US
Mailing Address - Phone:253-630-6614
Mailing Address - Fax:253-630-6624
Practice Address - Street 1:16720 SE 271ST ST STE 203
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-7342
Practice Address - Country:US
Practice Address - Phone:253-630-6614
Practice Address - Fax:253-630-6624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty