Provider Demographics
NPI:1225536428
Name:NW ORTHOPAEDIC MASSAGE
Entity Type:Organization
Organization Name:NW ORTHOPAEDIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATC/L, LMT
Authorized Official - Phone:425-776-6966
Mailing Address - Street 1:7500 212TH ST SW STE 101
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7614
Mailing Address - Country:US
Mailing Address - Phone:425-776-6966
Mailing Address - Fax:425-776-6969
Practice Address - Street 1:7500 212TH ST SW STE 101
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7614
Practice Address - Country:US
Practice Address - Phone:425-776-6966
Practice Address - Fax:425-776-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022740225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty