Provider Demographics
NPI:1356591291
Name:BOUALOYS MASSAGE LLC
Entity type:Organization
Organization Name:BOUALOYS MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMP
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOUALOY
Authorized Official - Middle Name:MANIVANH
Authorized Official - Last Name:ABANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-992-6798
Mailing Address - Street 1:689 STRANDER BLVD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2922
Mailing Address - Country:US
Mailing Address - Phone:206-992-6798
Mailing Address - Fax:
Practice Address - Street 1:689 STRANDER BLVD
Practice Address - Street 2:BUILDING C
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188
Practice Address - Country:US
Practice Address - Phone:206-992-6798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty