MEDICARE: MS. LARRA DUTTON LMP, CLT

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	172M00000X	Mechanotherapist	MA 60205863	WA

General Provider Information

NPI Number	:	1518263730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LARRA DUTTON LMP, CLT

Provider Business Mailing Address
First Line	:	5615 PHINNEY AVE N APT 1
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5855
Country	:	US
Telephone Number	:	206-601-9994
Fax Number	:

Provider Business Practice Location Address
First Line	:	2366 EASTLAKE AVE E STE 217
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-6501
Country	:	US
Telephone Number	:	206-601-9994
Fax Number	:

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

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	09/15/2012

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