Provider Demographics
NPI:1265478713
Name:JEFFRIES, TIANN M (PT)
Entity Type:Individual
Prefix:
First Name:TIANN
Middle Name:M
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 NW GILMAN BLVD STE C108
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5326
Mailing Address - Country:US
Mailing Address - Phone:425-391-6794
Mailing Address - Fax:425-391-1525
Practice Address - Street 1:730 NW GILMAN BLVD STE C108
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5326
Practice Address - Country:US
Practice Address - Phone:425-391-6794
Practice Address - Fax:425-391-1525
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8391716Medicaid
WA8391716Medicaid