Provider Demographics
NPI:1447066436
Name:PACIFIC NORTHWEST MASSAGE AND CRYOTHERAPY, LLC
Entity type:Organization
Organization Name:PACIFIC NORTHWEST MASSAGE AND CRYOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAENNA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:JANUARY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:561-945-7683
Mailing Address - Street 1:7609 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2808
Mailing Address - Country:US
Mailing Address - Phone:561-945-7683
Mailing Address - Fax:206-260-4339
Practice Address - Street 1:1 LAKE BELLEVUE DR STE 208
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2417
Practice Address - Country:US
Practice Address - Phone:561-945-7683
Practice Address - Fax:206-260-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty