Provider Demographics
NPI:1881936235
Name:ABBOTT, ARLAND DECASTRO (LMP)
Entity type:Individual
Prefix:
First Name:ARLAND
Middle Name:DECASTRO
Last Name:ABBOTT
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 1:2537 S G ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4337
Mailing Address - Country:US
Mailing Address - Phone:253-228-1320
Mailing Address - Fax:
Practice Address - Street 1:1804 W UNION AVE
Practice Address - Street 2:STE. 101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2062
Practice Address - Country:US
Practice Address - Phone:253-759-4036
Practice Address - Fax:253-759-4341
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60290878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist