Provider Demographics
NPI:1861639528
Name:TOUCH OF GRACE MASSAGE AND WELL-SPA, LLC
Entity type:Organization
Organization Name:TOUCH OF GRACE MASSAGE AND WELL-SPA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MENBER1/MANAGER LLC
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PETERS-POONKASEM
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-241-0118
Mailing Address - Street 1:2522 N PROCTOR ST
Mailing Address - Street 2:#507
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5338
Mailing Address - Country:US
Mailing Address - Phone:253-241-0118
Mailing Address - Fax:
Practice Address - Street 1:1114 COURT E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-2002
Practice Address - Country:US
Practice Address - Phone:253-241-0118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60036366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty