Provider Demographics
NPI:1053462614
Name:LAVIN, WENDY E (MPT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:E
Last Name:LAVIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14741 22ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7302
Mailing Address - Country:US
Mailing Address - Phone:206-817-2676
Mailing Address - Fax:206-326-1398
Practice Address - Street 1:4464 FREMONT AVE N STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7290
Practice Address - Country:US
Practice Address - Phone:206-817-5896
Practice Address - Fax:206-326-1398
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA91-1889011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB20575Medicare ID - Type Unspecified