Healthcare Provider Details

I. General information

NPI: 1588032338
Provider Name (Legal Business Name): LARA HARDOBY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 S 3RD AVE STE 102
EVERETT WA
98203-2515
US

IV. Provider business mailing address

4423 S 3RD AVE STE 102
EVERETT WA
98203-2515
US

V. Phone/Fax

Practice location:
  • Phone: 253-250-5151
  • Fax: 425-426-0067
Mailing address:
  • Phone: 253-250-5151
  • Fax: 425-426-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60597662
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: