Provider Demographics
NPI:1245502749
Name:SEATTLE THERAPEUTICS PS
Entity type:Organization
Organization Name:SEATTLE THERAPEUTICS PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:D.C
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOURBONNAIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:206-547-5677
Mailing Address - Street 1:701 N 36TH ST STE #420
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8868
Mailing Address - Country:US
Mailing Address - Phone:206-547-5677
Mailing Address - Fax:206-547-5598
Practice Address - Street 1:701 N 36TH ST STE #420
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8868
Practice Address - Country:US
Practice Address - Phone:206-547-5677
Practice Address - Fax:206-547-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60159887225700000X
WAMA00019319172M00000X
WAMA00012837225700000X
WAMA60247265172M00000X
WAMA60258024225700000X
WAMA00023264174400000X
WAMA60303918225700000X
WAMA00018784225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty