Provider Demographics
NPI:1073940391
Name:BE WELL MASSAGE THERAPY, LLC
Entity Type:Organization
Organization Name:BE WELL MASSAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-381-3866
Mailing Address - Street 1:11811 MUKILTEO SPEEDWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5442
Mailing Address - Country:US
Mailing Address - Phone:425-381-3866
Mailing Address - Fax:425-290-8051
Practice Address - Street 1:11811 MUKILTEO SPEEDWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5442
Practice Address - Country:US
Practice Address - Phone:425-381-3866
Practice Address - Fax:425-290-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty