Provider Demographics
NPI:1558501767
Name:WINTER ROSE BODY THERAPY INC
Entity type:Organization
Organization Name:WINTER ROSE BODY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:GAYDOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-459-7673
Mailing Address - Street 1:422 CARPENTER RD SE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7906
Mailing Address - Country:US
Mailing Address - Phone:360-459-7673
Mailing Address - Fax:866-880-4246
Practice Address - Street 1:422 CARPENTER RD SE
Practice Address - Street 2:SUITE 104
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-7906
Practice Address - Country:US
Practice Address - Phone:360-459-7673
Practice Address - Fax:866-880-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020229225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty