Provider Demographics
NPI:1750075636
Name:BALLARD CENTRAL MASSAGE CLINIC LLC
Entity type:Organization
Organization Name:BALLARD CENTRAL MASSAGE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:COMPLITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-795-6273
Mailing Address - Street 1:1551 NW 54TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3845
Mailing Address - Country:US
Mailing Address - Phone:206-829-9198
Mailing Address - Fax:206-784-7471
Practice Address - Street 1:1551 NW 54TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3845
Practice Address - Country:US
Practice Address - Phone:206-829-9198
Practice Address - Fax:206-784-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center