Provider Demographics
NPI:1881921567
Name:ARVIDSON, DANIEL WILLIAM (LMP,CES,PES)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:WILLIAM
Last Name:ARVIDSON
Suffix:
Gender:M
Credentials:LMP,CES,PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15508 COUNTRY CLUB DR
Mailing Address - Street 2:A48
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1729
Mailing Address - Country:US
Mailing Address - Phone:206-861-5839
Mailing Address - Fax:
Practice Address - Street 1:15508 COUNTRY CLUB DR
Practice Address - Street 2:A48
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1729
Practice Address - Country:US
Practice Address - Phone:206-861-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1656442255A2300X
WAMA60103755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer