Provider Demographics
NPI:1962778761
Name:ESSENTIAL LIFE THERAPY
Entity type:Organization
Organization Name:ESSENTIAL LIFE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMEELA
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-633-5433
Mailing Address - Street 1:1333 N NORTHLAKE WAY STE G
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8900
Mailing Address - Country:US
Mailing Address - Phone:206-633-5433
Mailing Address - Fax:
Practice Address - Street 1:1333 N NORTHLAKE WAY STE G
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8900
Practice Address - Country:US
Practice Address - Phone:206-633-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013484225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty