Provider Demographics
NPI:1154455103
Name:GAYDOS, APRIL ROSE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:APRIL
Middle Name:ROSE
Last Name:GAYDOS
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 1:422 CARPENTER RD SE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7906
Mailing Address - Country:US
Mailing Address - Phone:360-459-7673
Mailing Address - Fax:
Practice Address - Street 1:422 CARPENTER RD SE
Practice Address - Street 2:SUITE 104
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-7906
Practice Address - Country:US
Practice Address - Phone:360-459-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020229225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist