Provider Demographics
NPI:1427430107
Name:LYDEN, EDWARD (LMT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LYDEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5711 24TH AVE NW
Mailing Address - Street 2:# 405
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5711 24TH AVE NW
Practice Address - Street 2:#405
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3456
Practice Address - Country:US
Practice Address - Phone:203-980-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist