Provider Demographics
NPI:1699272260
Name:NORTHWEST MASSAGE LLC
Entity type:Organization
Organization Name:NORTHWEST MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:KATERI
Authorized Official - Middle Name:CHEYENNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:360-521-6090
Mailing Address - Street 1:100 E 13TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3329
Mailing Address - Country:US
Mailing Address - Phone:360-521-6090
Mailing Address - Fax:
Practice Address - Street 1:100 E 13TH ST STE 111
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3329
Practice Address - Country:US
Practice Address - Phone:360-521-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty