Healthcare Provider Details

I. General information

NPI: 1700491925
Provider Name (Legal Business Name): MIZU MASSAGE SEATTLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 AIRPORTWAY SOUTH 740
SEATTLE WA
98134
US

IV. Provider business mailing address

3250 AIRPORTWAY SOUTH 740
SEATTLE WA
98134
US

V. Phone/Fax

Practice location:
  • Phone: 253-304-3755
  • Fax:
Mailing address:
  • Phone: 253-304-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATRINA ARIEL GRAY
Title or Position: MASSAGE THERAPIST
Credential: LMP
Phone: 253-304-3755