1851627699 NPI number — M IS FOR MASSAGE, PLLC

Table of content: (NPI 1851627699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851627699 NPI number — M IS FOR MASSAGE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M IS FOR MASSAGE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851627699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4715 S HUDSON ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98118-2076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-819-9664
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2119 17TH AVENUE SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144-4313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-819-9664
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VERMILLION
Authorized Official First Name:
ROY
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
206-819-9664

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  #MA60069631 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , with the licence number: #MA60089955 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)