Provider Demographics
NPI:1376809558
Name:PAULS, AGLOW DAWNING
Entity Type:Individual
Prefix:
First Name:AGLOW
Middle Name:DAWNING
Last Name:PAULS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AGLOW
Other - Middle Name:DAWNING
Other - Last Name:PAULS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:18430 20TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6985
Mailing Address - Country:US
Mailing Address - Phone:206-228-2137
Mailing Address - Fax:
Practice Address - Street 1:18430 20TH DR SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6985
Practice Address - Country:US
Practice Address - Phone:206-228-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60270535225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist