Healthcare Provider Details

I. General information

NPI: 1548549819
Provider Name (Legal Business Name): TINA S. HULL LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 RACQUET LN SUITE 100
YAKIMA WA
98902-6114
US

IV. Provider business mailing address

706 SARATOGA ST
GRANITE FALLS WA
98252-8714
US

V. Phone/Fax

Practice location:
  • Phone: 509-452-5155
  • Fax:
Mailing address:
  • Phone: 509-833-3557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60235342
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: