Provider Demographics
NPI:1780128843
Name:HENRY PHAN
Entity type:Organization
Organization Name:HENRY PHAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-669-8281
Mailing Address - Street 1:1818 E MERCER ST
Mailing Address - Street 2:UNIT 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4689
Mailing Address - Country:US
Mailing Address - Phone:206-327-9328
Mailing Address - Fax:
Practice Address - Street 1:1818 E MERCER ST
Practice Address - Street 2:UNIT 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4689
Practice Address - Country:US
Practice Address - Phone:206-327-9328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60708325225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty