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General NPI Number Information
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NPI Number | 1104221571
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Entity Type | Organization
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Legal Business Name | A MOMENT FOR YOU PLLC
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 650 S ORCAS ST STE 219
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City | SEATTLE
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State | WA
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Zip | 98108-2652
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Country | US
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Telephone | 206-456-4463
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Fax | 855-272-1649
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Provider Business Mailing Address
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Address Line | 650 S ORCAS ST SUITE 219
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City | SEATTLE
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State | WA
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Zip | 98108
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Country | US
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Telephone | 206-456-4463
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Fax | 855-272-1649
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Authorized Official
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Title or Position | MANAGER/OWNER/LMP
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Name | MR. BRYAN T DEFORREST
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Credential | MA
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Telephone | 206-601-8334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60306672
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60075925
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License Number State | WA
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