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General NPI Number Information
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NPI Number | 1326412867
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Entity Type | Organization
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Legal Business Name | LAKE WASHINGTON MASSAGE THERAPY
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 15965 NE 85TH ST SUITE 102
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City | REDMOND
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State | WA
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Zip | 98052-3593
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Country | US
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Telephone | 425-882-9065
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Fax |
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Provider Business Mailing Address
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Address Line | 15965 NE 85TH ST SUITE 102
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City | REDMOND
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State | WA
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Zip | 98052-3593
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Country | US
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Telephone | 425-882-9065
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIELLE BROOKS
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Credential |
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Telephone | 425-882-9065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | MA60606643
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License Number State | WA
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