| NPI | 1104221571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN T DEFORREST Manager/Owner/Lmp 206-601-8334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60075925) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60306672) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2017-08-29 |