Provider Demographics
NPI:1114156106
Name:OWEN, TYHRA (LMP)
Entity Type:Individual
Prefix:
First Name:TYHRA
Middle Name:
Last Name:OWEN
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 1:120 E BIRCH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3054
Mailing Address - Country:US
Mailing Address - Phone:509-540-2413
Mailing Address - Fax:
Practice Address - Street 1:120 E BIRCH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3054
Practice Address - Country:US
Practice Address - Phone:509-540-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021270225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist