Provider Demographics
NPI:1134258940
Name:ADVANCED MASSAGE, LLC
Entity type:Organization
Organization Name:ADVANCED MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LUCILE
Authorized Official - Last Name:MERRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-244-7973
Mailing Address - Street 1:15513 AMBAUM BLVD. S.W.
Mailing Address - Street 2:STE. 102
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166
Mailing Address - Country:US
Mailing Address - Phone:206-244-7973
Mailing Address - Fax:206-244-2613
Practice Address - Street 1:15513 AMBAUM BLVD. S.W.
Practice Address - Street 2:STE. 102
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-244-7973
Practice Address - Fax:206-244-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009864225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty