MEDICARE: MATTHEW EVAN KENDALL LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA61549051	WA

General Provider Information

NPI Number	:	1396579264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW EVAN KENDALL LMP

Provider Business Mailing Address
First Line	:	1020 NE 63RD ST UNIT 415
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-6673
Country	:	US
Telephone Number	:	831-233-4913
Fax Number	:

Provider Business Practice Location Address
First Line	:	4464 FREMONT AVE N STE 2
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-7273
Country	:	US
Telephone Number	:	206-801-9251
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2024
Last Update Date	:	08/31/2024

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