Provider Demographics
NPI:1386860781
Name:HERRIN, MATTHEW WOODSON (LMP MA00023238)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:WOODSON
Last Name:HERRIN
Suffix:
Gender:M
Credentials:LMP MA00023238
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10212 5TH AVE NE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7452
Mailing Address - Country:US
Mailing Address - Phone:206-440-1634
Mailing Address - Fax:206-374-8202
Practice Address - Street 1:10212 5TH AVE NE
Practice Address - Street 2:SUITE 140
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7452
Practice Address - Country:US
Practice Address - Phone:206-440-1634
Practice Address - Fax:206-374-8202
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023238172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist