Provider Demographics
NPI:1770736910
Name:LALLI, VINCENZO BIAGIO
Entity type:Individual
Prefix:MR
First Name:VINCENZO
Middle Name:BIAGIO
Last Name:LALLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 BOYLSTON AVE E
Mailing Address - Street 2:SUITE # 306
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3079
Mailing Address - Country:US
Mailing Address - Phone:206-328-7331
Mailing Address - Fax:206-260-7505
Practice Address - Street 1:2815 BOYLSTON AVE E
Practice Address - Street 2:SUITE # 306
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3079
Practice Address - Country:US
Practice Address - Phone:206-328-7331
Practice Address - Fax:206-260-7505
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60043255225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist