Healthcare Provider Details

I. General information

NPI: 1083127047
Provider Name (Legal Business Name): THERESA AMANA TUIASOSOPO NT61363998
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 S 320TH ST STE E
FEDERAL WAY WA
98003-5254
US

IV. Provider business mailing address

PO BOX 293
AUBURN WA
98071-0293
US

V. Phone/Fax

Practice location:
  • Phone: 253-237-4704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT61363998
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60792094
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: