Healthcare Provider Details

I. General information

NPI: 1164913653
Provider Name (Legal Business Name): ELIZABETH TATUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S 347TH PL
FEDERAL WAY WA
98003-6718
US

IV. Provider business mailing address

34603 4TH PL S
FEDERAL WAY WA
98003-6729
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-3777
  • Fax:
Mailing address:
  • Phone: 858-784-1942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: