Provider Demographics
NPI:1902131675
Name:EASTSIDE OASIS DAY SPA & MASSAGE THERAPY LLC
Entity Type:Organization
Organization Name:EASTSIDE OASIS DAY SPA & MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TORRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-614-3037
Mailing Address - Street 1:14044 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4129
Mailing Address - Country:US
Mailing Address - Phone:425-614-3037
Mailing Address - Fax:425-643-0876
Practice Address - Street 1:14044 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4129
Practice Address - Country:US
Practice Address - Phone:425-614-3037
Practice Address - Fax:425-643-0876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018115225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty