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PUYALLUP WELLNESS, PLLC

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Company Details

Legal Name: PUYALLUP WELLNESS, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: October 18th 2019
Expiration date: 31 Oct 2025
UBI Number: 604 522 685
ZIP code: 98373
City: Puyallup
County: PIERCE
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 2802 S MERIDIAN, PUYALLUP, WA, 98373-1402, UNITED STATES
Principal Office Mailing Address: Google Maps Logo 7910 PACIFIC AVE, TACOMA, WA, 98408-7031, UNITED STATES

Contact Details

E-Mail: CGIBSON@PIVOTALLAWGROUP.COM

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
PARKER MOOERS & CENA, LLC Registered Agent 9222 BAY SHORE DR NW STE 150, SILVERDALE, WA, 98383-7870, UNITED STATES

Key Officers & Management

Name Role Address
TARA PETERSON Executor 1200 5TH AVE STE 1217, SEATTLE, WA, 98101-3115, UNITED STATES
BRAD MUNDT Governing Person -
SAHIBJIT GILL Governing Person -

National Provider Identifier

NPI Number:
1639714850

Authorized Person:

Name:
DR. BRADLEY MUNDT
Role:
CLINIC DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
171100000X - Acupuncturist
Is Primary:
No
Selected Taxonomy:
225700000X - Massage Therapist
Is Primary:
No
Selected Taxonomy:
111N00000X - Chiropractor
Is Primary:
Yes

Contacts:

Fax:
2538450129
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