Provider Demographics
NPI:1437282241
Name:MATHIASEN, ADAM K (LMP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:K
Last Name:MATHIASEN
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 1:2815 HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2611
Mailing Address - Country:US
Mailing Address - Phone:360-224-4249
Mailing Address - Fax:
Practice Address - Street 1:904 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5223
Practice Address - Country:US
Practice Address - Phone:360-650-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016457225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0216329OtherLABOR & INDUSTRY