Provider Demographics
NPI:1568949451
Name:DUBOIS, NATHANIEL ALEXANDER (LMT)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:ALEXANDER
Last Name:DUBOIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 21ST AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2911
Mailing Address - Country:US
Mailing Address - Phone:206-617-8944
Mailing Address - Fax:
Practice Address - Street 1:1801 NW MARKET ST STE 408
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3901
Practice Address - Country:US
Practice Address - Phone:206-784-2800
Practice Address - Fax:206-784-5257
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025293225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist