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General NPI Number Information
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NPI Number | 1962778761
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Entity Type | Organization
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Legal Business Name | ESSENTIAL LIFE THERAPY
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 1333 N NORTHLAKE WAY STE G
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City | SEATTLE
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State | WA
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Zip | 98103-8900
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Country | US
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Telephone | 206-633-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 N NORTHLAKE WAY STE G
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City | SEATTLE
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State | WA
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Zip | 98103-8900
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Country | US
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Telephone | 206-633-5433
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DENA JAMEELA
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Credential | LMP
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Telephone | 206-633-5433
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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 | MA00013484
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License Number State | WA
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