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NPI Code Detail

MEDICARE: LARA M DOW

MEDICARE: LARA M DOW
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
1225100000XPhysical TherapistPT00009744WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15650DOOTHERWAREGENCE/BS
20211090OTHERWADEPT. OF LABOR & INDUSTRY
30007DOOTHERWAREGENCE BLUE SHIELD
44460DOOTHERWAREGENCE BLUE SHIELD

General Provider Information

NPI Number : 1750459681
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARA M DOW
Provider Business Mailing Address
First Line : 1519 132ND ST SE
Second Line : SUITE A
City : EVERETT
State : WA
Zip : 98208-7203
Country : US
Telephone Number : 425-330-0633
Fax Number : 425-338-9637
Provider Business Practice Location Address
First Line : 22500 NE MARKETPLACE DR
Second Line : SUITE 204
City : REDMOND
State : WA
Zip : 98053-2033
Country : US
Telephone Number : 425-836-1034
Fax Number : 425-836-1037
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 10/10/2007

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Directions to “ LARA M DOW ” Practice Location

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