Provider Demographics
NPI:1598022527
Name:SOUND WELLNESS MASSAGE, LLC
Entity Type:Organization
Organization Name:SOUND WELLNESS MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEDERER
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-661-2360
Mailing Address - Street 1:3417 EVANSTON AVE N STE 227
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8686
Mailing Address - Country:US
Mailing Address - Phone:206-661-2360
Mailing Address - Fax:
Practice Address - Street 1:3417 EVANSTON AVE N STE 227
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8686
Practice Address - Country:US
Practice Address - Phone:206-661-2360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60226311225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty