Provider Demographics
NPI:1760502223
Name:GOLDIN, LARISA
Entity Type:Individual
Prefix:MS
First Name:LARISA
Middle Name:
Last Name:GOLDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22701 42ND PL W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4526
Mailing Address - Country:US
Mailing Address - Phone:425-778-6258
Mailing Address - Fax:
Practice Address - Street 1:902 NE 65TH ST
Practice Address - Street 2:STE B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5562
Practice Address - Country:US
Practice Address - Phone:206-267-0863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist