Provider Demographics
NPI:1386389518
Name:LIFESTYLES MASSAGE
Entity type:Organization
Organization Name:LIFESTYLES MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFCIICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-443-3226
Mailing Address - Street 1:1468 OLNEY AVE SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4078
Mailing Address - Country:US
Mailing Address - Phone:360-443-2267
Mailing Address - Fax:
Practice Address - Street 1:1468 OLNEY AVE SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4078
Practice Address - Country:US
Practice Address - Phone:360-443-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty