Provider Demographics
NPI:1063850931
Name:TOWNSEND, CORY JOE (LMT)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:JOE
Last Name:TOWNSEND
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 NE 72ND DR STE 15
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7300
Mailing Address - Country:US
Mailing Address - Phone:360-260-6903
Mailing Address - Fax:
Practice Address - Street 1:3021 NE 72ND DR STE 15
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7300
Practice Address - Country:US
Practice Address - Phone:360-260-6903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60331031225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist