Provider Demographics
NPI:1023004025
Name:CHAN, LYNN MARIE MASON (PT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE MASON
Last Name:CHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:MARIE
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11700 NE ANGELO DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4296
Mailing Address - Country:US
Mailing Address - Phone:360-260-0679
Mailing Address - Fax:360-260-0689
Practice Address - Street 1:852 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2406
Practice Address - Country:US
Practice Address - Phone:360-501-3750
Practice Address - Fax:360-501-3755
Is Sole Proprietor?:No
Enumeration Date:2005-09-25
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA133605OtherLABOR & IND
OR182150Medicaid
650021893OtherRR MEDICARE
WA8340820Medicaid
WAAB13130Medicare PIN
S96364Medicare UPIN