Provider Demographics
NPI:1306210869
Name:ATWATER, LOIS (CMT)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:ATWATER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2801 OCEAN PARK BLVD
Mailing Address - Street 2:#251
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2905
Mailing Address - Country:US
Mailing Address - Phone:310-463-3601
Mailing Address - Fax:424-558-3240
Practice Address - Street 1:1001 W CARSON ST
Practice Address - Street 2:STE. E
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2051
Practice Address - Country:US
Practice Address - Phone:310-463-3601
Practice Address - Fax:424-558-3240
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA27598225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist