Provider Demographics
NPI:1891113528
Name:MONROE THERAPEUTIC MASSAGE, P.S.
Entity type:Organization
Organization Name:MONROE THERAPEUTIC MASSAGE, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-802-1382
Mailing Address - Street 1:11911 NE 132ND ST
Mailing Address - Street 2:STE 101
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2900
Mailing Address - Country:US
Mailing Address - Phone:425-814-8300
Mailing Address - Fax:425-814-2004
Practice Address - Street 1:21605 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7514
Practice Address - Country:US
Practice Address - Phone:425-814-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty