Provider Demographics
NPI:1679868962
Name:M3 BODYWORKS LLC
Entity Type:Organization
Organization Name:M3 BODYWORKS LLC
Other - Org Name:M3 BODYWORKS MASSAGE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-331-3999
Mailing Address - Street 1:5236 CALIFORNIA AVE SW
Mailing Address - Street 2:SUITE D
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1244
Mailing Address - Country:US
Mailing Address - Phone:206-331-3999
Mailing Address - Fax:206-388-3226
Practice Address - Street 1:5236 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE D
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1244
Practice Address - Country:US
Practice Address - Phone:206-331-3999
Practice Address - Fax:206-388-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019519225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty