Provider Demographics
NPI:1194835553
Name:LAVIN, REBECCA C (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:C
Last Name:LAVIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10733 221ST LN NE STE A
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-2002
Mailing Address - Country:US
Mailing Address - Phone:206-271-0622
Mailing Address - Fax:206-319-4450
Practice Address - Street 1:10733 221ST LN NE STE A
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053
Practice Address - Country:US
Practice Address - Phone:206-271-0622
Practice Address - Fax:206-319-4450
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015720225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0232274OtherLABOR & INDUSTRIES
WA2500LAOtherREGENCE BLUE SHIELD
WA0212515OtherDEPT. OF LABOR & INDUSTRY
WA8942480OtherL&I CRIME VICTIMS
WA0212515OtherDEPT. OF LABOR & INDUSTRY