Organization
CLARK THERAPEUTIC MASSAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA PATRICIA CLARK LMP (OWNER)
(253) 847-2687
Entity
Organization
Contact information
Practice address
10107 213TH ST E, GRAHAM, WA 98338-8059
(253) 847-2687
(253) 846-3012
Mailing address
PO BOX 988, GRAHAM, WA 98338-0988
(253) 847-2687
(253) 846-3012
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00004428
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
66473
L&I NUMBER
WA
01
—
7694CL
REGENCE PROVIDER NUMBER
WA
Enumeration date
01/30/2007
Last updated
08/22/2020
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