Provider Demographics
NPI:1710389747
Name:NW MEDICAL MASSAGE & BODYWORK
Entity Type:Organization
Organization Name:NW MEDICAL MASSAGE & BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUESA
Authorized Official - Middle Name:RAQUEL
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:206-861-3727
Mailing Address - Street 1:512 NE 103RD ST APT C406
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7463
Mailing Address - Country:US
Mailing Address - Phone:206-861-3727
Mailing Address - Fax:
Practice Address - Street 1:19122 BEARDSLEE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-0200
Practice Address - Country:US
Practice Address - Phone:206-861-3727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025027225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty