1124581434 NPI number — STRESS RELIEF SOLUTIONS

Table of content: (NPI 1124581434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124581434 NPI number — STRESS RELIEF SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRESS RELIEF SOLUTIONS
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:
STRESS RELIEF SOLUTIONS
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:
1124581434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 BLACK HILLS LN SW STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98502-8146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-763-9439
Provider Business Mailing Address Fax Number:
360-252-6139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 BLACK HILLS LN SW STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98502-8146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-763-9439
Provider Business Practice Location Address Fax Number:
360-252-6139
Provider Enumeration Date:
04/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MCDADE
Authorized Official First Name:
CLYDE
Authorized Official Middle Name:
O
Authorized Official Title or Position:
CERTIFIED NEUROMUSCULAR THERAPIST
Authorized Official Telephone Number:
360-763-9439

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1124581434 . This is a "ORGANIZATION NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com