=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205773983
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE BELLOUSOV
-----------------------------------------------------
Gender |
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2026
-----------------------------------------------------
Last Update Date | 05/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4030 ALDERWOOD MALL BLVD
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98036-6763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-776-0803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2717 144TH CT SE
-----------------------------------------------------
City | MILL CREEK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98012-5741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MASS.MA.70095486
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------