Provider Demographics
NPI:1962876409
Name:NORTHWEST MASSAGE AND HOLISTIC HEALING CENTER
Entity type:Organization
Organization Name:NORTHWEST MASSAGE AND HOLISTIC HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PEDREY
Authorized Official - Suffix:
Authorized Official - Credentials:MA60303219
Authorized Official - Phone:360-477-8553
Mailing Address - Street 1:145 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-4107
Mailing Address - Country:US
Mailing Address - Phone:360-477-8553
Mailing Address - Fax:360-443-4203
Practice Address - Street 1:145 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-4107
Practice Address - Country:US
Practice Address - Phone:360-477-8553
Practice Address - Fax:360-443-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60303219225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty