Provider Demographics
NPI:1407099419
Name:EDMONDS WELLNESS MASSAGE AND ACUPUNCTURE
Entity Type:Organization
Organization Name:EDMONDS WELLNESS MASSAGE AND ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:KEHAULANI
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-776-3800
Mailing Address - Street 1:21920 76TH AVE W
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7980
Mailing Address - Country:US
Mailing Address - Phone:425-776-3800
Mailing Address - Fax:425-776-8344
Practice Address - Street 1:21920 76TH AVE W
Practice Address - Street 2:SUITE 130
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7980
Practice Address - Country:US
Practice Address - Phone:425-776-3800
Practice Address - Fax:425-776-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021455174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA193400000XOtherTAXONOMY