Provider Demographics
NPI:1144576950
Name:ADVANCED MEDICAL MASSAGE
Entity type:Organization
Organization Name:ADVANCED MEDICAL MASSAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENCED MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TANJA
Authorized Official - Middle Name:
Authorized Official - Last Name:JURICIC
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-527-9566
Mailing Address - Street 1:1112 FINNEGAN WAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6622
Mailing Address - Country:US
Mailing Address - Phone:360-527-9566
Mailing Address - Fax:360-527-8534
Practice Address - Street 1:1112 FINNEGAN WAY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6622
Practice Address - Country:US
Practice Address - Phone:360-527-9566
Practice Address - Fax:360-527-8534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602207584225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty