Provider Demographics
NPI:1245487347
Name:SOUTHSOUND TREATMENT MASSAGE
Entity type:Organization
Organization Name:SOUTHSOUND TREATMENT MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:RESSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:253-841-2200
Mailing Address - Street 1:PO BOX 731245
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0060
Mailing Address - Country:US
Mailing Address - Phone:253-841-2200
Mailing Address - Fax:253-848-1075
Practice Address - Street 1:818 39TH AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3308
Practice Address - Country:US
Practice Address - Phone:253-841-2200
Practice Address - Fax:253-848-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009118174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty