Provider Demographics
NPI:1043458284
Name:GOODWIN, DORIT (LMP)
Entity Type:Individual
Prefix:MS
First Name:DORIT
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17547
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98127-1247
Mailing Address - Country:US
Mailing Address - Phone:206-501-8784
Mailing Address - Fax:
Practice Address - Street 1:164 KNECHTEL WAY NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2838
Practice Address - Country:US
Practice Address - Phone:206-501-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist