Provider Demographics
NPI:1174731749
Name:NORTH SOUND MASSAGE, LLC
Entity type:Organization
Organization Name:NORTH SOUND MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-348-4649
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-0673
Mailing Address - Country:US
Mailing Address - Phone:425-348-4649
Mailing Address - Fax:425-348-0478
Practice Address - Street 1:2615 W CASINO RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-2124
Practice Address - Country:US
Practice Address - Phone:425-348-4649
Practice Address - Fax:425-348-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty