Provider Demographics
NPI:1306302880
Name:CHELAN VALLEY MASSAGE THERAPY
Entity type:Organization
Organization Name:CHELAN VALLEY MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-682-8888
Mailing Address - Street 1:20 PINE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ORONDO
Mailing Address - State:WA
Mailing Address - Zip Code:98843-9691
Mailing Address - Country:US
Mailing Address - Phone:509-682-8888
Mailing Address - Fax:
Practice Address - Street 1:20 PINE HOLLOW DR
Practice Address - Street 2:
Practice Address - City:ORONDO
Practice Address - State:WA
Practice Address - Zip Code:98843-9691
Practice Address - Country:US
Practice Address - Phone:509-682-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAXWELL EMPIRE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty