Provider Demographics
NPI:1972185403
Name:ORIGIN SEATTLE BODYWORK
Entity Type:Organization
Organization Name:ORIGIN SEATTLE BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:206-234-9478
Mailing Address - Street 1:4444 WOODLAND PARK AVE N UNIT 201
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7499
Mailing Address - Country:US
Mailing Address - Phone:206-234-9478
Mailing Address - Fax:
Practice Address - Street 1:4444 WOODLAND PARK AVE N UNIT 201
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7499
Practice Address - Country:US
Practice Address - Phone:206-234-9478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty