Provider Demographics
NPI:1912303892
Name:DOWER, EVAN (LMP)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:DOWER
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 1:3712 S PILGRIM ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-5247
Mailing Address - Country:US
Mailing Address - Phone:717-673-8268
Mailing Address - Fax:
Practice Address - Street 1:3712 S PILGRIM ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-5247
Practice Address - Country:US
Practice Address - Phone:717-673-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60431105225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist