Provider Demographics
NPI:1497992317
Name:CORNWELL, LINDSEY (LMP)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:CORNWELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24922 KIMRE PL NE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-8226
Mailing Address - Country:US
Mailing Address - Phone:360-731-2257
Mailing Address - Fax:
Practice Address - Street 1:24922 KIMRE PL NE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-8226
Practice Address - Country:US
Practice Address - Phone:360-731-2257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60035444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist