Provider Demographics
NPI:1083998850
Name:TAMMY RICHERT, LMP
Entity Type:Organization
Organization Name:TAMMY RICHERT, LMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:RICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-903-8742
Mailing Address - Street 1:1710 W MAIN ST STE 218
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4318
Mailing Address - Country:US
Mailing Address - Phone:360-903-8742
Mailing Address - Fax:
Practice Address - Street 1:1710 W MAIN ST STE 218
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4318
Practice Address - Country:US
Practice Address - Phone:360-903-8742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008409261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1700839180OtherNPI TYPE 1