Provider Demographics
NPI:1275815326
Name:WALKER, TIEGAN (LMP)
Entity Type:Individual
Prefix:MS
First Name:TIEGAN
Middle Name:
Last Name:WALKER
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 1:13313 103RD LN NE APT G104
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2061
Mailing Address - Country:US
Mailing Address - Phone:425-455-2225
Mailing Address - Fax:425-454-7767
Practice Address - Street 1:10655 NE 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5022
Practice Address - Country:US
Practice Address - Phone:425-455-2225
Practice Address - Fax:425-454-7767
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60022704225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60022704OtherWA STATE LICENSE