Provider Demographics
NPI:1366988495
Name:LUMINOUS MASSAGE & BODY WORK
Entity type:Organization
Organization Name:LUMINOUS MASSAGE & BODY WORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:IVORY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:720-360-9451
Mailing Address - Street 1:6000 NE 35TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7229
Mailing Address - Country:US
Mailing Address - Phone:720-360-9451
Mailing Address - Fax:
Practice Address - Street 1:2006 MAIN ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2637
Practice Address - Country:US
Practice Address - Phone:360-906-0826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60699064305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization