Provider Demographics
NPI:1376947747
Name:ALIGN BODYWORKS PLLC
Entity type:Organization
Organization Name:ALIGN BODYWORKS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DERAMO
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-495-0220
Mailing Address - Street 1:16040 NORTHUP WAY
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2541
Mailing Address - Country:US
Mailing Address - Phone:425-495-0220
Mailing Address - Fax:
Practice Address - Street 1:16040 NORTHUP WAY
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2541
Practice Address - Country:US
Practice Address - Phone:425-495-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00017396261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center