Provider Demographics
NPI:1942748512
Name:HORIKAWA, MATT (LMP)
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:
Last Name:HORIKAWA
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 E SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1925
Mailing Address - Country:US
Mailing Address - Phone:707-601-7998
Mailing Address - Fax:
Practice Address - Street 1:4280 MERIDIAN ST STE 120
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6464
Practice Address - Country:US
Practice Address - Phone:360-734-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60728287225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist