Provider Demographics
NPI:1215187752
Name:WILSON, TESS E (LMP)
Entity Type:Individual
Prefix:
First Name:TESS
Middle Name:E
Last Name:WILSON
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 1:13555 BEL RED RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2397
Mailing Address - Country:US
Mailing Address - Phone:425-455-2320
Mailing Address - Fax:425-455-2473
Practice Address - Street 1:13555 BEL RED RD
Practice Address - Street 2:SUITE 205
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2397
Practice Address - Country:US
Practice Address - Phone:425-455-2320
Practice Address - Fax:425-455-2473
Is Sole Proprietor?:No
Enumeration Date:2008-09-20
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist