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General NPI Number Information
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NPI Number | 1598043598
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Entity Type | Individual
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Provider Name | TYNIA AMON KERCHEVAL PTA
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Gender | Female
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 491 S 338TH ST
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6290
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Country | US
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Telephone | 253-661-4466
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Fax |
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Provider Business Mailing Address
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Address Line | 16104 123RD AVENUE CT E
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City | PUYALLUP
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State | WA
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Zip | 98374-9658
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Country | US
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Telephone | 206-293-1422
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 60031531
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License Number State | WA
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