Healthcare Provider Details

I. General information

NPI: 1033402342
Provider Name (Legal Business Name): NORTHGATE MASSAGE , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N NORTHGATE WAY
SEATTLE WA
98133-8913
US

IV. Provider business mailing address

1111 N NORTHGATE WAY
SEATTLE WA
98133-8913
US

V. Phone/Fax

Practice location:
  • Phone: 206-523-2225
  • Fax: 206-523-9101
Mailing address:
  • Phone: 206-523-2225
  • Fax: 206-523-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID J KRALL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 206-523-2225