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Organization
MASSAGE RESTORATION LLC
Active
Organization
MASSAGE RESTORATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACLYN JUNE MONGE SOUTHARD LMT (OWNER)
(360) 388-0485
Entity
Organization
Contact information
Practice address
4520 INTELCO LOOP SE BLDG 3, LACEY, WA 98503-6008
(360) 388-0485
(360) 890-4066
Mailing address
9649 LOOKOUT DR NW, OLYMPIA, WA 98502-9757
(360) 388-0485
(360) 890-4066
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
11/22/2020
Last updated
11/22/2020
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