Healthcare Provider Details

I. General information

NPI: 1558556993
Provider Name (Legal Business Name): TOTAL WELLNESS THERAPEUTIC MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4347 ROOSEVELT WAY NE
SEATTLE WA
98105-4717
US

IV. Provider business mailing address

PO BOX 22245
SEATTLE WA
98122-0245
US

V. Phone/Fax

Practice location:
  • Phone: 206-423-7922
  • Fax: 206-633-5559
Mailing address:
  • Phone: 206-423-7922
  • Fax: 206-633-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number594681
License Number StateWA

VIII. Authorized Official

Name: KEALOHA TAYLOR
Title or Position: OWNER
Credential: L.M.T.
Phone: 206-423-7922