Provider Demographics
NPI:1992911614
Name:MONROE THERAPEUTIC MASSAGE PS
Entity type:Organization
Organization Name:MONROE THERAPEUTIC MASSAGE PS
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 1:509 OLIVE WAY
Mailing Address - Street 2:STE 755
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1773
Mailing Address - Country:US
Mailing Address - Phone:206-264-9400
Mailing Address - Fax:206-264-4939
Practice Address - Street 1:509 OLIVE WAY
Practice Address - Street 2:STE 755
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1773
Practice Address - Country:US
Practice Address - Phone:206-264-9400
Practice Address - Fax:206-264-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty