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General NPI Number Information
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NPI Number | 1063288116
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Entity Type | Individual
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Provider Name | TIYARA BENNY
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Gender | Female
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 12/24/2025
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Provider Practice Location Address
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Address Line | 13128 TOTEM LAKE BLVD NE STE 204
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City | KIRKLAND
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State | WA
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Zip | 98034-2953
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Country | US
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Telephone | 425-820-8474
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Fax |
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Provider Business Mailing Address
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Address Line | 1482 GREAT SHOALS DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7088
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Country | US
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Telephone | 404-709-1225
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT61503619
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License Number State | WA
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