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General NPI Number Information
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NPI Number | 1679868962
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Entity Type | Organization
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Legal Business Name | M3 BODYWORKS LLC
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 06/14/2011
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Provider Practice Location Address
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Address Line | 5236 CALIFORNIA AVE SW SUITE D
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City | SEATTLE
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State | WA
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Zip | 98136-1244
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Country | US
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Telephone | 206-331-3999
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Fax | 206-388-3226
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Provider Business Mailing Address
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Address Line | 5236 CALIFORNIA AVE SW SUITE D
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City | SEATTLE
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State | WA
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Zip | 98136-1244
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Country | US
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Telephone | 206-331-3999
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Fax | 206-388-3226
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL J MANDELL
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Credential | LMP
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Telephone | 206-331-3999
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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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