Provider Demographics
NPI:1750753364
Name:SEATTLE MASSAGE PRO
Entity type:Organization
Organization Name:SEATTLE MASSAGE PRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-909-2994
Mailing Address - Street 1:2711 E MADISON ST
Mailing Address - Street 2:STE#201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4749
Mailing Address - Country:US
Mailing Address - Phone:206-909-2994
Mailing Address - Fax:206-922-2053
Practice Address - Street 1:2711 E MADISON ST
Practice Address - Street 2:STE#201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4749
Practice Address - Country:US
Practice Address - Phone:206-909-2994
Practice Address - Fax:206-922-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60240007225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty