Healthcare Provider Details

I. General information

NPI: 1245602382
Provider Name (Legal Business Name): TIFFANY ZAPHIA MA60605175
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W HILL ST
MONROE WA
98272-1460
US

IV. Provider business mailing address

507 102ND DR SE APT C1
LAKE STEVENS WA
98258-3957
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-6620
  • Fax: 360-794-9863
Mailing address:
  • Phone: 425-737-1060
  • Fax: 360-794-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60605175
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: