Provider Demographics
NPI:1194509885
Name:DEEP MYO MASSAGE
Entity type:Organization
Organization Name:DEEP MYO MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:REMINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-419-3038
Mailing Address - Street 1:10264 S BLENDU WAY
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-6842
Mailing Address - Country:US
Mailing Address - Phone:425-419-3038
Mailing Address - Fax:719-465-0357
Practice Address - Street 1:10264 S BLENDU WAY
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-6842
Practice Address - Country:US
Practice Address - Phone:425-419-3038
Practice Address - Fax:719-465-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty