Provider Demographics
NPI:1275832388
Name:PROUDSWORTH, TARYN MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:MARIE
Last Name:PROUDSWORTH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22840 NE 8TH ST UNIT 211
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7280
Mailing Address - Country:US
Mailing Address - Phone:425-374-9885
Mailing Address - Fax:
Practice Address - Street 1:22840 NE 8TH ST UNIT 211
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7280
Practice Address - Country:US
Practice Address - Phone:425-374-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60172520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist