Provider Demographics
NPI:1891169991
Name:ATHLETIC STRETCH THERAPY
Entity Type:Organization
Organization Name:ATHLETIC STRETCH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SIOBHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:208-486-6683
Mailing Address - Street 1:118 105TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5913
Mailing Address - Country:US
Mailing Address - Phone:206-486-6683
Mailing Address - Fax:206-858-9655
Practice Address - Street 1:118 105TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5913
Practice Address - Country:US
Practice Address - Phone:206-486-6683
Practice Address - Fax:206-858-9655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60299782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty