Provider Demographics
NPI:1649938242
Name:KUPERSTEIN, MICHAEL SPENCER (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SPENCER
Last Name:KUPERSTEIN
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 LAKE WASHINGTON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1110
Mailing Address - Country:US
Mailing Address - Phone:845-444-0148
Mailing Address - Fax:
Practice Address - Street 1:4248 LAKE WASHINGTON BLVD SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1110
Practice Address - Country:US
Practice Address - Phone:845-444-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60897071225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist