Provider Demographics
NPI:1396185146
Name:FROULA, MANDY ALENE (MASSAGE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:ALENE
Last Name:FROULA
Suffix:
Gender:F
Credentials:MASSAGE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11040 34TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6806
Mailing Address - Country:US
Mailing Address - Phone:206-390-8800
Mailing Address - Fax:
Practice Address - Street 1:6850 35TH AVE NE
Practice Address - Street 2:SUITE 7
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7344
Practice Address - Country:US
Practice Address - Phone:206-390-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60377059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist