Provider Demographics
NPI:1235426388
Name:BOUVIER, WILLIAM MICHAEL (LMT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:BOUVIER
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 1:12310 N DIVISION ST
Mailing Address - Street 2:STE.105
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1998
Mailing Address - Country:US
Mailing Address - Phone:509-891-1999
Mailing Address - Fax:
Practice Address - Street 1:12310 N DIVISION ST
Practice Address - Street 2:STE.105
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1998
Practice Address - Country:US
Practice Address - Phone:509-891-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60214520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist