Healthcare Provider Details

I. General information

NPI: 1992251599
Provider Name (Legal Business Name): ANDERS KOBBEVIK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NE 65TH STREET
SEATTLE WA
98115
US

IV. Provider business mailing address

3710 27TH PL W UNIT 107
SEATTLE WA
98199-2080
US

V. Phone/Fax

Practice location:
  • Phone: 206-522-4000
  • Fax:
Mailing address:
  • Phone: 253-569-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60320241
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: