Provider Demographics
NPI:1669657441
Name:MYAKOTA-ROWAN, LYDIA J (LMT)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:J
Last Name:MYAKOTA-ROWAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:MYAKOTA-ROWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:4308 SW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-1052
Mailing Address - Country:US
Mailing Address - Phone:206-935-2909
Mailing Address - Fax:
Practice Address - Street 1:4308 SW 100TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-1052
Practice Address - Country:US
Practice Address - Phone:206-935-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-30
Last Update Date:2007-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013913174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist