Provider Demographics
NPI:1033562459
Name:ROBECK, TIFFANY K (LMT/LMP)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:K
Last Name:ROBECK
Suffix:
Gender:F
Credentials:LMT/LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 NW 80TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3646
Mailing Address - Country:US
Mailing Address - Phone:206-617-8162
Mailing Address - Fax:206-237-9066
Practice Address - Street 1:1812 NW 80TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3646
Practice Address - Country:US
Practice Address - Phone:206-617-8162
Practice Address - Fax:206-237-9066
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010840225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist