Healthcare Provider Details

I. General information

NPI: 1336511989
Provider Name (Legal Business Name): PAIN & WELLNESS INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 VIRGINIA STREET UNIT 1805
SEATTLE WA
98101
US

IV. Provider business mailing address

819 VIRGINIA STREET UNIT 1805
SEATTLE WA
98101
US

V. Phone/Fax

Practice location:
  • Phone: 816-835-2026
  • Fax:
Mailing address:
  • Phone: 816-835-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOP 60544461
License Number StateWA

VIII. Authorized Official

Name: DR. MICHAEL MASSEY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 816-835-2026