Provider Demographics
NPI:1194269456
Name:THE GARAGE MASSAGE THERAPY, PLLC
Entity type:Organization
Organization Name:THE GARAGE MASSAGE THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:G
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:425-998-6542
Mailing Address - Street 1:710 5TH AVE NW
Mailing Address - Street 2:STE 300
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-998-6542
Mailing Address - Fax:425-332-7071
Practice Address - Street 1:3946 TOLT AVE
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014
Practice Address - Country:US
Practice Address - Phone:425-998-6542
Practice Address - Fax:425-443-1797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE GARAGE MASSAGE THERAPY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-06
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60555501225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty