Provider Demographics
NPI:1902229750
Name:RAWLERSON, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RAWLERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99533
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-0533
Mailing Address - Country:US
Mailing Address - Phone:253-327-5563
Mailing Address - Fax:
Practice Address - Street 1:3701 S ORCHARD ST
Practice Address - Street 2:APT D8
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98466-6743
Practice Address - Country:US
Practice Address - Phone:253-327-5563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60261624225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist