Provider Demographics
NPI:1043984982
Name:VANWERT, JAMES (LMT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:VANWERT
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 1:482 MARIETTA LOOP
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-9593
Mailing Address - Country:US
Mailing Address - Phone:360-610-5029
Mailing Address - Fax:
Practice Address - Street 1:1233 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6554
Practice Address - Country:US
Practice Address - Phone:360-610-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist