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General NPI Number Information
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NPI Number | 1265983555
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Entity Type | Individual
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Provider Name | EDWIN BAXTER LMP
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Gender | Male
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 14313 NE 20TH AVE A112
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City | VANCOUVER
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State | WA
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Zip | 98686-1487
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Country | US
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Telephone | 360-574-9440
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Fax |
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Provider Business Mailing Address
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Address Line | 3508 N ST
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City | VANCOUVER
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State | WA
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Zip | 98663-2440
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Country | US
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Telephone | 360-852-7424
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 60690259
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License Number State | WA
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