Provider Demographics
NPI:1669514451
Name:MATSUDA, TERRY (LMP)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:MATSUDA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23727 SE 36TH LN
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-6337
Mailing Address - Country:US
Mailing Address - Phone:425-394-1290
Mailing Address - Fax:425-391-1660
Practice Address - Street 1:5825 221ST PL SE
Practice Address - Street 2:SUITE 204
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8927
Practice Address - Country:US
Practice Address - Phone:425-394-1290
Practice Address - Fax:425-391-1660
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist