Provider Demographics
NPI:1033342241
Name:VASEY, TARA L (LMP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:VASEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21009 76TH AVE W
Mailing Address - Street 2:AXIS PHYSICAL THERAPY
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7126
Mailing Address - Country:US
Mailing Address - Phone:425-672-2910
Mailing Address - Fax:420-778-1872
Practice Address - Street 1:21009 76TH AVE W
Practice Address - Street 2:AXIS PHYSICAL THERAPY
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7126
Practice Address - Country:US
Practice Address - Phone:425-672-2910
Practice Address - Fax:420-778-1872
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012997225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist