Provider Demographics
NPI:1255979837
Name:RELAX MIND & BODY MASSAGE PLLC
Entity type:Organization
Organization Name:RELAX MIND & BODY MASSAGE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:INGRUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:360-631-9965
Mailing Address - Street 1:3710 168TH ST NE STE B102
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8463
Mailing Address - Country:US
Mailing Address - Phone:360-631-9965
Mailing Address - Fax:360-322-6606
Practice Address - Street 1:3710 168TH ST NE STE B102
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8463
Practice Address - Country:US
Practice Address - Phone:360-631-9965
Practice Address - Fax:360-322-6606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-14
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty