1295800399 NPI number — KNEADING HANDS MASSAGE THERAPY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295800399 NPI number — KNEADING HANDS MASSAGE THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KNEADING HANDS MASSAGE THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MONROE MEDICAL MASSAGE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295800399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17066 BEATON RD SE
Provider Second Line Business Mailing Address:
SUITE 170
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98272-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-863-0960
Provider Business Mailing Address Fax Number:
360-863-8710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17066 BEATON RD SE
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98272-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-863-0960
Provider Business Practice Location Address Fax Number:
360-863-8710
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZYLSTRA
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-863-0960

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA00010802 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: MA00019954 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MA00020051 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MA00021601 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: MA00020587 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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