Provider Demographics
NPI:1255502985
Name:GAYLORD, MATTHEW RICHARD (LMP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:RICHARD
Last Name:GAYLORD
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 MELROSE AVE E APT 206
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5281
Mailing Address - Country:US
Mailing Address - Phone:360-510-2843
Mailing Address - Fax:
Practice Address - Street 1:1666 E OLIVE WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5627
Practice Address - Country:US
Practice Address - Phone:206-323-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025298225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist