Provider Demographics
NPI:1881076636
Name:NELSON, CARRIE SARAH (LMP)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:SARAH
Last Name:NELSON
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 1:19207 60TH AVE W
Mailing Address - Street 2:#1
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5111
Mailing Address - Country:US
Mailing Address - Phone:206-306-6032
Mailing Address - Fax:
Practice Address - Street 1:19207 60TH AVE W
Practice Address - Street 2:#1
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5111
Practice Address - Country:US
Practice Address - Phone:206-306-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-28
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008992172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist