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General NPI Number Information
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NPI Number | 1770623977
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Entity Type | Individual
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Provider Name | TRISHA BERTHOLF LMP
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 5775 SOUNDVIEW DR STE# 101C
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City | GIG HARBOR
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State | WA
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Zip | 98335-2211
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Country | US
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Telephone | 253-564-2920
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Fax | 253-514-8110
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Provider Business Mailing Address
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Address Line | 2310 MILDRED ST W # 130
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-6036
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Country | US
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Telephone | 253-564-2920
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Fax | 253-564-0135
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00010739
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License Number State | WA
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