MEDICARE: MS. TAMMY DEROCHE DPT

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
1	225100000X	Physical Therapist	PT00009705	WA
2	225100000X	Physical Therapist	70010260	IL
3	225100000X	Physical Therapist	PTL-6970	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7111645	OTHER	WA	AETNA
3	196053	OTHER	WA	DEPT OF LABOR & INDUSTRY
4	8906265	OTHER	WA	CRIME VICTIMS
5	4295DE	OTHER	WA	REGENCE BLUE SHIELD

General Provider Information

NPI Number	:	1215905278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMMY DEROCHE DPT

Provider Business Mailing Address
First Line	:	6520 226TH PL SE
Second Line	:	SUITE 205
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-8969
Country	:	US
Telephone Number	:	425-392-8611
Fax Number	:	425-392-9012

Provider Business Practice Location Address
First Line	:	6520 226TH PL SE
Second Line	:	SUITE 205
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-8969
Country	:	US
Telephone Number	:	425-392-8611
Fax Number	:	425-392-9012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	07/09/2013

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Directions to “ MS. TAMMY DEROCHE DPT” Practice Location

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