Basic Information
Provider Information
NPI: 1033556048
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: USHER
FirstName: MATTHEW
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 670 NW GILMAN BLVD
Address2: STE B2
City: ISSAQUAH
State: WA
PostalCode: 980272444
CountryCode: US
TelephoneNumber: 4254276562
FaxNumber:  
Practice Location
Address1: 670 NW GILMAN BLVD
Address2: STE B2
City: ISSAQUAH
State: WA
PostalCode: 980272444
CountryCode: US
TelephoneNumber: 4254276562
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/30/2013
LastUpdateDate: 05/30/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225700000XMA00022609WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist 

No ID Information.


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