Provider Demographics
NPI:1700657830
Name:ESSENTIAL MASSAGE WW LLC
Entity Type:Organization
Organization Name:ESSENTIAL MASSAGE WW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:LAMEE
Authorized Official - Last Name:LESLEI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:509-520-3402
Mailing Address - Street 1:5210 RUSSELL AVE NW APT 112
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3937
Mailing Address - Country:US
Mailing Address - Phone:509-520-3402
Mailing Address - Fax:833-463-1707
Practice Address - Street 1:4208 LEARY WAY NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4535
Practice Address - Country:US
Practice Address - Phone:509-520-3402
Practice Address - Fax:833-463-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service