Provider Demographics
NPI:1154123305
Name:DAVIDSON, LAWRENCE IV (LMT)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:DAVIDSON
Suffix:IV
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13325 94TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-5502
Mailing Address - Country:US
Mailing Address - Phone:252-288-7836
Mailing Address - Fax:
Practice Address - Street 1:13325 94TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5502
Practice Address - Country:US
Practice Address - Phone:252-288-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA6165770225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist