Self Balance Massage

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60042214 Issued in WA

Legal business name

SELF BALANCE MASSAGE

Practice address

5107 NE 94TH Ave Ste a
Vancouver, WA 98662-6188

Phone

(360) 202-7085

Fax

(801) 501-7085

NPI assigned

Mar 18, 2014

Last updated

Mar 18, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Teresa L Bonawitz, LMP

Title

Co-Owner

Phone

(360) 202-7085

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395100800000",
    "number": "1659798437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5107 NE 94TH AVE STE A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626188",
            "telephone_number": "360-202-7085",
            "fax_number": "801-501-7085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5107 NE 94TH AVE STE A",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626188",
            "telephone_number": "360-202-7085",
            "fax_number": "801-501-7085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF BALANCE MASSAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-18",
        "last_updated": "2014-03-18",
        "status": "A",
        "authorized_official_last_name": "BONAWITZ",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "360-202-7085",
        "authorized_official_credential": "LMP"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60042214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Michelle Seitz, MD
• Elizabeth Selden, M.S. CCC-SLP
• Amy Seldomridge, M.S., CCC-SLP
• Select Physical Therapy Orthopedic Services Inc
• Self Balance Massage
• Victoria Self
• Charles Christopher Selhorst, RN, LAC, EAMP
• Rachel Seligman, OT
• Randi Lynn Sellek
• Adisyn Marie Sellers

• Massage Therapist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.