Provider Demographics
NPI:1902115371
Name:MEDICAL MASSAGE INC
Entity Type:Organization
Organization Name:MEDICAL MASSAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-736-2853
Mailing Address - Street 1:1800 COOKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9072
Mailing Address - Country:US
Mailing Address - Phone:360-736-2853
Mailing Address - Fax:360-736-4159
Practice Address - Street 1:1800 COOKS HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9072
Practice Address - Country:US
Practice Address - Phone:360-736-2853
Practice Address - Fax:360-736-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty