=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851750863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEN THAI MASSAGE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2016
-----------------------------------------------------
Last Update Date | 02/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 NW 42ND ST
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98107-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-802-8560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2440 140TH AVE NE APT 17
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98005-1856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-802-8560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRITTANY QUON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-802-8560
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | MA 60159285
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------