Healthcare Provider Details

I. General information

NPI: 1689224982
Provider Name (Legal Business Name): THERAPY MANAGEMENT SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21525 STATE ROUTE 410 E STE B
BONNEY LAKE WA
98391-4101
US

IV. Provider business mailing address

915 118TH AVE SE STE 110
BELLEVUE WA
98005-3875
US

V. Phone/Fax

Practice location:
  • Phone: 253-826-8520
  • Fax: 253-826-8522
Mailing address:
  • Phone: 425-450-9474
  • Fax: 425-452-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DWAN AYALA
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 425-450-9474