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General NPI Number Information
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NPI Number | 1851627699
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Entity Type | Organization
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Legal Business Name | M IS FOR MASSAGE, PLLC
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 2119 17TH AVENUE SOUTH
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City | SEATTLE
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State | WA
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Zip | 98144-4313
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Country | US
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Telephone | 206-819-9664
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Fax |
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Provider Business Mailing Address
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Address Line | 4715 S HUDSON ST.
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City | SEATTLE
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State | WA
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Zip | 98118-2076
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Country | US
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Telephone | 206-819-9664
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. ROY ALAN VERMILLION
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Credential | LMP
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Telephone | 206-819-9664
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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 | #MA60089955
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | #MA60069631
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License Number State | WA
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