Healthcare Provider Details

I. General information

NPI: 1245502749
Provider Name (Legal Business Name): SEATTLE THERAPEUTICS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 36TH ST STE #420
SEATTLE WA
98103-8868
US

IV. Provider business mailing address

701 N 36TH ST STE #420
SEATTLE WA
98103-8868
US

V. Phone/Fax

Practice location:
  • Phone: 206-547-5677
  • Fax: 206-547-5598
Mailing address:
  • Phone: 206-547-5677
  • Fax: 206-547-5598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA00019319
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA60247265
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00023264
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00018784
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60159887
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00012837
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60258024
License Number StateWA
# 8
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60303918
License Number StateWA

VIII. Authorized Official

Name: MICHAEL D BOURBONNAIS
Title or Position: D.C
Credential: DC
Phone: 206-547-5677