Provider Demographics
NPI:1427439058
Name:IGH MASSAGE, LLC
Entity type:Organization
Organization Name:IGH MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/LMP
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-547-2286
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:SULTAN
Mailing Address - State:WA
Mailing Address - Zip Code:98294-1068
Mailing Address - Country:US
Mailing Address - Phone:360-547-2286
Mailing Address - Fax:
Practice Address - Street 1:18122 STATE ROUTE 9 SE
Practice Address - Street 2:SUITE I
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-5384
Practice Address - Country:US
Practice Address - Phone:360-547-2286
Practice Address - Fax:425-527-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60210556225700000X
WAMA 60229655225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1952693335OtherNPI
WA1568745586OtherNPI