Basic Information
| Provider Information | |||||||||
| NPI: | 1881936235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABBOTT | ||||||||
| FirstName: | ARLAND | ||||||||
| MiddleName: | DECASTRO | ||||||||
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| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2537 S G ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532281320 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1804 W UNION AVE | ||||||||
| Address2: | STE. 101 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984052062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537594036 | ||||||||
| FaxNumber: | 2537594341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2013 | ||||||||
| LastUpdateDate: | 05/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA60290878 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.