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General NPI Number Information
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NPI Number | 1588115901
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Entity Type | Organization
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Legal Business Name | SPA ALEXIS LLC
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 2110 116TH AVE NE SUITE C
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City | BELLEVUE
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State | WA
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Zip | 98004-3040
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Country | US
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Telephone | 206-946-2040
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Fax | 206-858-9202
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Provider Business Mailing Address
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Address Line | 2110 116TH AVE NE SUITE C
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City | BELLEVUE
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State | WA
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Zip | 98004-3040
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Country | US
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Telephone | 206-946-2040
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Fax | 206-858-9202
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | MS. ALEXIS E KURTZMAN
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Credential | LMP, LMT, LMTI
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Telephone | 206-946-2040
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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 | MA 60330731
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License Number State | WA
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