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General NPI Number Information
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NPI Number | 1124664651
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Entity Type | Organization
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Legal Business Name | ROOTS FOR HEALTH PLLC
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 7621 AURORA AVE N
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City | SEATTLE
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State | WA
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Zip | 98103-4749
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Country | US
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Telephone | 206-588-1061
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Fax | 206-297-6118
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Provider Business Mailing Address
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Address Line | 1212 NW 105TH ST
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City | SEATTLE
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State | WA
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Zip | 98177-5229
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Country | US
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Telephone | 312-282-8463
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CORTNEY CUSACK
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Credential | ND
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Telephone | 312-282-8463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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