Provider Demographics
NPI:1184126518
Name:STUDIO MASSAGE LLC
Entity type:Organization
Organization Name:STUDIO MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CIANA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HILTON-FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:425-264-5060
Mailing Address - Street 1:4300 TALBOT RD S STE 304
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6238
Mailing Address - Country:US
Mailing Address - Phone:425-264-5060
Mailing Address - Fax:
Practice Address - Street 1:4300 TALBOT RD S STE 304
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6238
Practice Address - Country:US
Practice Address - Phone:425-264-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60204592225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00024732OtherAMBYR RECCHI LMT
WA60149353OtherBRANDI HIGBEE LMT
WA60095030OtherLACEY MCALLISTER LMT
WA60692887OtherADRIANNA OBREGON LMT
WA00009931OtherTISHA CHRSTENSON-DILLON LMT
WA60204592OtherCIANA HILTON-FARMER LMT
WA60611098OtherNICOLE ZIMMERMAN LMT