Provider Demographics
NPI:1558710194
Name:WILLFUL MASSAGE
Entity type:Organization
Organization Name:WILLFUL MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVASSEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-998-8277
Mailing Address - Street 1:165 17TH AVE
Mailing Address - Street 2:#106
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5764
Mailing Address - Country:US
Mailing Address - Phone:425-998-8277
Mailing Address - Fax:206-960-4058
Practice Address - Street 1:165 17TH AVE
Practice Address - Street 2:#106
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5764
Practice Address - Country:US
Practice Address - Phone:425-998-8277
Practice Address - Fax:206-960-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-05
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603571144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty