Provider Demographics
NPI:1699326066
Name:ENUMCLAW THERAPEUTIC MASSAGE LLC
Entity type:Organization
Organization Name:ENUMCLAW THERAPEUTIC MASSAGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-691-6396
Mailing Address - Street 1:661 GODAWA LN
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922
Mailing Address - Country:US
Mailing Address - Phone:253-691-6396
Mailing Address - Fax:360-226-3945
Practice Address - Street 1:411 SWIFTWATER BLVD.
Practice Address - Street 2:SUITE 214.3
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922
Practice Address - Country:US
Practice Address - Phone:253-691-6396
Practice Address - Fax:844-235-2037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty