Provider Demographics
NPI:1285207092
Name:BARR, MAYALIN LAFORTEZA (DPT)
Entity Type:Individual
Prefix:
First Name:MAYALIN
Middle Name:LAFORTEZA
Last Name:BARR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MAYALIN
Other - Middle Name:BORROMEO
Other - Last Name:LAFORTEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27500 102ND AVE NW STE 1
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8092
Mailing Address - Country:US
Mailing Address - Phone:360-629-7528
Mailing Address - Fax:
Practice Address - Street 1:1819 S LAKE STEVENS RD
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2060
Practice Address - Country:US
Practice Address - Phone:425-334-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61151200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist