Organization
BACK TO FORM STRUCTURAL STRENGTH AND MASSAGE
Active
Other names
PNW Massage & Sport
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN LEE VANDENBOSCH LMP (OWNER/LMP)
(206) 383-3186
Entity
Organization
Contact information
Practice address
509 OLIVE WAY STE 851, SEATTLE, WA 98101-1769
(206) 383-3186
Mailing address
509 OLIVE WAY STE 851, SEATTLE, WA 98101-1769
(206) 383-3186
(206) 397-3458
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60255380
WA
225700000X
Massage Therapist
MA60546268
WA
Other
Enumeration date
08/18/2017
Last updated
07/21/2022
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