Provider Demographics
NPI:1487106407
Name:LO, ANDREW (LMP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LO
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 1:12426 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2606
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 AURORA AVE NORTH
Practice Address - Street 2:SUITE 216
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4080
Practice Address - Country:US
Practice Address - Phone:206-715-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60680139225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist