Provider Demographics
NPI:1992121560
Name:THE V SPA
Entity type:Organization
Organization Name:THE V SPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-352-3400
Mailing Address - Street 1:4833 TUMWATER VALLEY DR SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4583
Mailing Address - Country:US
Mailing Address - Phone:360-352-3400
Mailing Address - Fax:360-352-2457
Practice Address - Street 1:4833 TUMWATER VALLEY DR SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4583
Practice Address - Country:US
Practice Address - Phone:360-352-3400
Practice Address - Fax:360-352-2457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA225700000XOtherMASSAGE THERAPIST