Healthcare Provider Details

I. General information

NPI: 1114382801
Provider Name (Legal Business Name): MATTHEW LAWSON LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13712 NE 20TH AVE A
VANCOUVER WA
98686-2698
US

IV. Provider business mailing address

13712 NE 20TH AVE A
VANCOUVER WA
98686-2698
US

V. Phone/Fax

Practice location:
  • Phone: 360-574-5944
  • Fax: 360-574-6430
Mailing address:
  • Phone: 360-574-5944
  • Fax: 360-574-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60567401
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: