Provider Demographics
NPI:1396579264
Name:KENDALL, MATTHEW EVAN (LMP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:EVAN
Last Name:KENDALL
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 1:1020 NE 63RD ST UNIT 415
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6673
Mailing Address - Country:US
Mailing Address - Phone:831-233-4913
Mailing Address - Fax:
Practice Address - Street 1:4464 FREMONT AVE N STE 2
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7273
Practice Address - Country:US
Practice Address - Phone:206-801-9251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61549051225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist