Provider Demographics
NPI:1689994071
Name:WAKING LIFE MASSAGE & SUPPLY, INC. PS
Entity Type:Organization
Organization Name:WAKING LIFE MASSAGE & SUPPLY, INC. PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-729-2024
Mailing Address - Street 1:1118 NE 47TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4617
Mailing Address - Country:US
Mailing Address - Phone:206-729-2024
Mailing Address - Fax:206-729-2512
Practice Address - Street 1:1118 NE 47TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4617
Practice Address - Country:US
Practice Address - Phone:206-729-2024
Practice Address - Fax:206-729-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty