Provider Demographics
NPI:1235198664
Name:NYSTROM, DAREN MCLEAN (MA, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:DAREN
Middle Name:MCLEAN
Last Name:NYSTROM
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Gender:M
Credentials:MA, ATC, CSCS
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Mailing Address - Street 1:6012 S 233RD PL
Mailing Address - Street 2:FF204
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-4855
Mailing Address - Country:US
Mailing Address - Phone:253-879-2813
Mailing Address - Fax:253-879-3634
Practice Address - Street 1:1500 N WARNER ST
Practice Address - Street 2:#1044
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98416-5000
Practice Address - Country:US
Practice Address - Phone:253-879-2813
Practice Address - Fax:253-879-3634
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer