Provider Demographics
NPI:1851564009
Name:LAKE WASHINGTON MASSAGE THERAPY INC
Entity Type:Organization
Organization Name:LAKE WASHINGTON MASSAGE THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-882-9065
Mailing Address - Street 1:6619 132ND AVE NE PMB 163
Mailing Address - Street 2:
Mailing Address - City:KUKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:425-882-9065
Mailing Address - Fax:425-558-1900
Practice Address - Street 1:8301 161ST AVE NE SUITE 201
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-882-9065
Practice Address - Fax:425-558-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008359225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty