Basic Information
| Provider Information | |||||||||
| NPI: | 1750459681 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOW | ||||||||
| FirstName: | LARA | ||||||||
| MiddleName: | M | ||||||||
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| OtherLastName: | VINSON | ||||||||
| OtherFirstName: | LARA | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherCredential: | MPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1519 132ND ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982087203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253300633 | ||||||||
| FaxNumber: | 4253389637 | ||||||||
| Practice Location | |||||||||
| Address1: | 22500 NE MARKETPLACE DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980532033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258361034 | ||||||||
| FaxNumber: | 4258361037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 10/10/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00009744 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 5650DO | 01 | WA | REGENCE/BS | OTHER | 0211090 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 0007DO | 01 | WA | REGENCE BLUE SHIELD | OTHER | 4460DO | 01 | WA | REGENCE BLUE SHIELD | OTHER |