Provider Demographics
NPI:1982066676
Name:EASTSIDE MASSAGE CLINIC, INC.
Entity Type:Organization
Organization Name:EASTSIDE MASSAGE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-455-2320
Mailing Address - Street 1:13555 BEL RED RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2397
Mailing Address - Country:US
Mailing Address - Phone:425-455-2320
Mailing Address - Fax:425-455-2473
Practice Address - Street 1:13555 BEL RED RD
Practice Address - Street 2:SUITE 205
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2397
Practice Address - Country:US
Practice Address - Phone:425-455-2320
Practice Address - Fax:425-455-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013518225700000X
WAMA60129791225700000X
WAMA00020094225700000X
WAMA60204513225700000X
WAMA60303920225700000X
WAMA60333626225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty