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General NPI Number Information
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NPI Number | 1700491925
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Entity Type | Organization
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Legal Business Name | MIZU MASSAGE SEATTLE LLC
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 3250 AIRPORTWAY SOUTH 740
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City | SEATTLE
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State | WA
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Zip | 98134
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Country | US
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Telephone | 253-304-3755
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 AIRPORTWAY SOUTH 740
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City | SEATTLE
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State | WA
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Zip | 98134
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Country | US
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Telephone | 253-304-3755
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | KATRINA ARIEL GRAY
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Credential | LMP
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Telephone | 253-304-3755
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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 |
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License Number State |
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