Provider Demographics
NPI:1558556993
Name:TOTAL WELLNESS THERAPEUTIC MASSAGE LLC
Entity Type:Organization
Organization Name:TOTAL WELLNESS THERAPEUTIC MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEALOHA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:206-423-7922
Mailing Address - Street 1:PO BOX 22245
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-0245
Mailing Address - Country:US
Mailing Address - Phone:206-423-7922
Mailing Address - Fax:206-633-5559
Practice Address - Street 1:4347 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4717
Practice Address - Country:US
Practice Address - Phone:206-423-7922
Practice Address - Fax:206-633-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA594681305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service