Provider Demographics
NPI:1699983957
Name:ESSENTIAL ELEMENTS MASSAGE
Entity type:Organization
Organization Name:ESSENTIAL ELEMENTS MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-297-7788
Mailing Address - Street 1:7624 52ND AVE E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98443-2745
Mailing Address - Country:US
Mailing Address - Phone:253-297-7788
Mailing Address - Fax:
Practice Address - Street 1:2024 54TH AVE E
Practice Address - Street 2:SUITE A
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-1901
Practice Address - Country:US
Practice Address - Phone:253-297-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
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