Provider Demographics
NPI:1023891025
Name:MIA'S MASSAGE LLC
Entity type:Organization
Organization Name:MIA'S MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-251-9055
Mailing Address - Street 1:1307 E 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-3425
Mailing Address - Country:US
Mailing Address - Phone:509-251-9055
Mailing Address - Fax:
Practice Address - Street 1:1106 N WASHINGTON ST STE D
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2205
Practice Address - Country:US
Practice Address - Phone:509-795-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty