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General NPI Number Information
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NPI Number | 1215905278
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Entity Type | Individual
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Provider Name | TAMMY DEROCHE DPT
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Gender | Female
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 6520 226TH PL SE SUITE 205
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City | ISSAQUAH
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State | WA
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Zip | 98027-8969
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Country | US
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Telephone | 425-392-8611
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Fax | 425-392-9012
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Provider Business Mailing Address
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Address Line | 6520 226TH PL SE SUITE 205
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City | ISSAQUAH
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State | WA
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Zip | 98027-8969
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Country | US
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Telephone | 425-392-8611
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Fax | 425-392-9012
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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 | PT00009705
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 70010260
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL-6970
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License Number State | CO
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