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General NPI Number Information
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NPI Number | 1518263730
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Entity Type | Individual
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Provider Name | LARRA DUTTON LMP, CLT
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Gender | Female
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 09/15/2012
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Provider Practice Location Address
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Address Line | 2366 EASTLAKE AVE E STE 217
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City | SEATTLE
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State | WA
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Zip | 98102-6501
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Country | US
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Telephone | 206-601-9994
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Fax |
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Provider Business Mailing Address
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Address Line | 5615 PHINNEY AVE N APT 1
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City | SEATTLE
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State | WA
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Zip | 98103-5855
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Country | US
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Telephone | 206-601-9994
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MA 60205863
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License Number State | WA
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