Healthcare Provider Details

I. General information

NPI: 1710389747
Provider Name (Legal Business Name): NW MEDICAL MASSAGE & BODYWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19122 BEARDSLEE BLVD STE 105
BOTHELL WA
98011-0200
US

IV. Provider business mailing address

512 NE 103RD ST APT C406
SEATTLE WA
98125-7463
US

V. Phone/Fax

Practice location:
  • Phone: 206-861-3727
  • Fax:
Mailing address:
  • Phone: 206-861-3727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00025027
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARQUESA RAQUEL NEWMAN
Title or Position: OWNER
Credential: LMT
Phone: 206-861-3727