Healthcare Provider Details

I. General information

NPI: 1700839180
Provider Name (Legal Business Name): TAMMY RICHERT LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18508 NE GABRIEL RD
YACOLT WA
98675-4108
US

IV. Provider business mailing address

501 E MCLOUGHLIN BLVD
VANCOUVER WA
98663-3356
US

V. Phone/Fax

Practice location:
  • Phone: 360-686-3580
  • Fax:
Mailing address:
  • Phone: 360-696-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00008409
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: