Provider Demographics
NPI:1952762387
Name:BLISSFUL KNEAD LLC
Entity type:Organization
Organization Name:BLISSFUL KNEAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PRAJNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TULADHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-272-0347
Mailing Address - Street 1:15513 AMBAUM BLVD SW
Mailing Address - Street 2:STE 102
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15513 AMBAUM BLVD SW
Practice Address - Street 2:STE 102
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2424
Practice Address - Country:US
Practice Address - Phone:206-939-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-12
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60532844225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty