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General NPI Number Information
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NPI Number | 1558710194
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Entity Type | Organization
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Legal Business Name | WILLFUL MASSAGE
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Dates
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Enumeration Date | 06/05/2016
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Last Update Date | 06/05/2016
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Provider Practice Location Address
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Address Line | 165 17TH AVE #106
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City | SEATTLE
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State | WA
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Zip | 98122-5764
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Country | US
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Telephone | 425-998-8277
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Fax | 206-960-4058
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Provider Business Mailing Address
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Address Line | 165 17TH AVE #106
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City | SEATTLE
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State | WA
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Zip | 98122-5764
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Country | US
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Telephone | 425-998-8277
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Fax | 206-960-4058
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Authorized Official
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Title or Position | OWNER
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Name | WILFRED LEVASSEUR
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Credential |
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Telephone | 425-998-8277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 603571144
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License Number State | WA
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