Provider Demographics
NPI:1750459681
Name:DOW, LARA M
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:M
Last Name:DOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:MARIE
Other - Last Name:VINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-330-0633
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:22500 NE MARKETPLACE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-2033
Practice Address - Country:US
Practice Address - Phone:425-836-1034
Practice Address - Fax:425-836-1037
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5650DOOtherREGENCE/BS
WA0211090OtherDEPT. OF LABOR & INDUSTRY
WA0007DOOtherREGENCE BLUE SHIELD
WA4460DOOtherREGENCE BLUE SHIELD
WA4460DOOtherREGENCE BLUE SHIELD
WA5650DOOtherREGENCE/BS