Provider Demographics
NPI:1083199327
Name:WAHLSTROM-TARBET, LINNEA JOY (LMT)
Entity Type:Individual
Prefix:
First Name:LINNEA
Middle Name:JOY
Last Name:WAHLSTROM-TARBET
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8524 STEILACOOM BLVD SW STE 201B
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4772
Mailing Address - Country:US
Mailing Address - Phone:253-722-5511
Mailing Address - Fax:253-722-5496
Practice Address - Street 1:8524 STEILACOOM BLVD SW STE 201B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4772
Practice Address - Country:US
Practice Address - Phone:253-722-5511
Practice Address - Fax:253-722-5496
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60850249174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60850249OtherLICENSED MASSAGE THERAPIST