Provider Demographics
NPI:1033402342
Name:NORTHGATE MASSAGE , INC
Entity Type:Organization
Organization Name:NORTHGATE MASSAGE , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-523-2225
Mailing Address - Street 1:1111 N NORTHGATE WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8913
Mailing Address - Country:US
Mailing Address - Phone:206-523-2225
Mailing Address - Fax:206-523-9101
Practice Address - Street 1:1111 N NORTHGATE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8913
Practice Address - Country:US
Practice Address - Phone:206-523-2225
Practice Address - Fax:206-523-9101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHGATE PAIN CONTROL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty