=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073057378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UP AND RUNNING MASSAGE THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2016
-----------------------------------------------------
Last Update Date | 12/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3216 NE 45TH PL STE 117
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98105-4093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-954-7404
-----------------------------------------------------
Fax | 206-641-7596
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3216 NE 45TH PL STE 117
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98105-4093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-954-7404
-----------------------------------------------------
Fax | 206-641-7596
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MASSAGE THERAPIST
-----------------------------------------------------
Name | ANN MILLIRON ESPINOSA
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 425-954-7404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA60184192
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------