Provider Demographics
NPI:1982907796
Name:PUGET SOUND MASSAGE LLC
Entity type:Organization
Organization Name:PUGET SOUND MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-348-4649
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-0663
Mailing Address - Country:US
Mailing Address - Phone:425-348-4649
Mailing Address - Fax:
Practice Address - Street 1:11611 AIRPORT RD
Practice Address - Street 2:SUITE 204
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3782
Practice Address - Country:US
Practice Address - Phone:425-348-4649
Practice Address - Fax:425-348-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty