Provider Demographics
NPI:1942604327
Name:DAWSON, JUANITA MAREE (LMT)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:MAREE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 BROADWAY
Mailing Address - Street 2:APT 3
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2369
Mailing Address - Country:US
Mailing Address - Phone:703-297-9532
Mailing Address - Fax:
Practice Address - Street 1:2114 BROADWAY
Practice Address - Street 2:APT 3
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2369
Practice Address - Country:US
Practice Address - Phone:703-297-9532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60494757225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist