Provider Demographics
NPI:1538300553
Name:MASBRUCH, HALEY NICOLE (LMP)
Entity type:Individual
Prefix:MS
First Name:HALEY
Middle Name:NICOLE
Last Name:MASBRUCH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:VAUGHN
Mailing Address - State:WA
Mailing Address - Zip Code:98394-0131
Mailing Address - Country:US
Mailing Address - Phone:253-677-1550
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:450 PORT ORCHARD BLVD
Practice Address - Street 2:HARBORVIEW MASSAGE & WELLNESS CENTER
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4705
Practice Address - Country:US
Practice Address - Phone:360-876-1114
Practice Address - Fax:253-284-0450
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60072923225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist