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NPI Code Detail

MEDICARE: TARA L VASEY LMP

MEDICARE: TARA L VASEY LMP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMA00012997WA

General Provider Information

NPI Number : 1033342241
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA L VASEY LMP
Provider Business Mailing Address
First Line : 21009 76TH AVE W
Second Line : AXIS PHYSICAL THERAPY
City : EDMONDS
State : WA
Zip : 98026-7126
Country : US
Telephone Number : 425-672-2910
Fax Number : 420-778-1872
Provider Business Practice Location Address
First Line : 21009 76TH AVE W
Second Line : AXIS PHYSICAL THERAPY
City : EDMONDS
State : WA
Zip : 98026-7126
Country : US
Telephone Number : 425-672-2910
Fax Number : 420-778-1872
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2009
Last Update Date : 09/03/2009

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Directions to “ TARA L VASEY LMP” Practice Location

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