Provider Demographics
NPI:1750953444
Name:BREEZE SPA LLC
Entity type:Organization
Organization Name:BREEZE SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-458-8010
Mailing Address - Street 1:8926 SATTERLEE AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-3504
Mailing Address - Country:US
Mailing Address - Phone:206-331-7675
Mailing Address - Fax:
Practice Address - Street 1:10657 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5727
Practice Address - Country:US
Practice Address - Phone:425-458-8010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty