=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891279279
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA CHRISTINA TAMEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2018
-----------------------------------------------------
Last Update Date | 09/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2445 3RD AVE S
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98134-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-252-0058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6112 14TH AVE NW APT 5
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98107-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-877-6433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | P160190932
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------