Provider Demographics
NPI:1205004777
Name:CENTURY MASSAGE & BODYWORK, INC
Entity Type:Organization
Organization Name:CENTURY MASSAGE & BODYWORK, INC
Other - Org Name:CENTURY MASSAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LYN
Authorized Official - Middle Name:FRIGILLANA
Authorized Official - Last Name:YANCHA
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-228-5217
Mailing Address - Street 1:15 S GRADY WAY
Mailing Address - Street 2:SUITE LL25
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-3220
Mailing Address - Country:US
Mailing Address - Phone:425-228-5217
Mailing Address - Fax:425-271-4189
Practice Address - Street 1:15 S GRADY WAY
Practice Address - Street 2:SUITE LL25
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3220
Practice Address - Country:US
Practice Address - Phone:425-228-5217
Practice Address - Fax:425-271-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012942174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA54-0196702OtherWA STATE DEPT OF L&I
WA620389900OtherACS PROVIDER NUMBER / OWCP