1518046952 NPI number — MRMASSAGE,INC.

Table of content: (NPI 1518046952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518046952 NPI number — MRMASSAGE,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MRMASSAGE,INC.
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:
1518046952
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:
643 S 305TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FEDERAL WAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98003-4021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-839-6058
Provider Business Mailing Address Fax Number:
180-066-0800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S 43RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98055-5714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-656-4006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CATE
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-839-6058

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA00011107 , 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: 123113 . This is a "WA L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CA9580 . This is a "REGENCE BLUSHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: MA00011107 . This is a "WA LIC." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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