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General NPI Number Information
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NPI Number | 1982066676
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Entity Type | Organization
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Legal Business Name | EASTSIDE MASSAGE CLINIC, INC.
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 13555 BEL RED RD SUITE 205
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City | BELLEVUE
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State | WA
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Zip | 98005-2397
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Country | US
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Telephone | 425-455-2320
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Fax | 425-455-2473
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Provider Business Mailing Address
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Address Line | 13555 BEL RED RD SUITE 205
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City | BELLEVUE
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State | WA
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Zip | 98005-2397
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Country | US
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Telephone | 425-455-2320
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Fax | 425-455-2473
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | LYNN A. DALTON
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Credential | LMP
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Telephone | 425-455-2320
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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 | MA60129791
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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 | MA00020094
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60204513
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60303920
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60333626
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License Number State | WA
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Taxonomy #6
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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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Taxonomy #7
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00013518
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License Number State | WA
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