1083040034 NPI number — ARN'S THERAPEUTIC MASSAGE

Table of content: (NPI 1083040034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083040034 NPI number — ARN'S THERAPEUTIC MASSAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARN'S THERAPEUTIC MASSAGE
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:
Provider Other Organization Name Type Code:
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:
1083040034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1913 NW 7TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATTLE GROUND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98604-6805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-521-0804
Provider Business Mailing Address Fax Number:
360-891-8000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5501 NE 109TH CT
Provider Second Line Business Practice Location Address:
SUITE L
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98662-6177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-521-0804
Provider Business Practice Location Address Fax Number:
360-891-8000
Provider Enumeration Date:
09/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ARN
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
Authorized Official Title or Position:
LMP
Authorized Official Telephone Number:
360-521-0804

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA00023548 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1033443007 . This is a "NPI TYPE 1" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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