Basic Information
| Provider Information | |||||||||
| NPI: | 1790990778 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONROE THERAPEUTIC MASSAGE PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 NW MARKET ST | ||||||||
| Address2: | STE 408 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067842800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1801 NW MARKET ST | ||||||||
| Address2: | STE 408 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067842800 | ||||||||
| FaxNumber: | 2067845257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 11/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | DESMOND | ||||||||
| AuthorizedOfficialFirstName: | GLYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4258021382 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LMP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.