Provider Demographics
NPI:1487287223
Name:UNIVERSITY PLACE MASSAGE, LLC
Entity type:Organization
Organization Name:UNIVERSITY PLACE MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEREMIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-330-9461
Mailing Address - Street 1:3318 BRIDGEPORT WAY W STE D2
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4598
Mailing Address - Country:US
Mailing Address - Phone:253-330-9461
Mailing Address - Fax:253-566-2322
Practice Address - Street 1:3318 BRIDGEPORT WAY W STE D2
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4598
Practice Address - Country:US
Practice Address - Phone:253-330-9461
Practice Address - Fax:253-565-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty