Provider Demographics
NPI:1962860650
Name:MASSAGE CENTER OF BELLEVUE
Entity Type:Organization
Organization Name:MASSAGE CENTER OF BELLEVUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMP
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-919-1996
Mailing Address - Street 1:17020 166TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8955
Mailing Address - Country:US
Mailing Address - Phone:206-919-1996
Mailing Address - Fax:
Practice Address - Street 1:17020 166TH PL NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8955
Practice Address - Country:US
Practice Address - Phone:206-919-1996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60619703225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60619703OtherMASSAGE THERAPY