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General NPI Number Information
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NPI Number | 1659419711
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Entity Type | Individual
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Provider Name | MICHAEL J MANDELL LMP
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 1709 HARBOR AVE SW SUITE 100
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City | SEATTLE
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State | WA
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Zip | 98126-2049
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Country | US
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Telephone | 206-535-2873
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Fax | 206-455-9184
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Provider Business Mailing Address
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Address Line | 4701 SW ADMIRAL WAY SUITE 18
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City | SEATTLE
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State | WA
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Zip | 98116-2340
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Country | US
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Telephone | 206-535-2873
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Fax | 206-455-9184
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA00019519
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License Number State | WA
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