Provider Demographics
NPI:1326511973
Name:TASANASANTA, CHARYLE RAE (LMP /MASSAGE THER)
Entity Type:Individual
Prefix:MRS
First Name:CHARYLE
Middle Name:RAE
Last Name:TASANASANTA
Suffix:
Gender:F
Credentials:LMP /MASSAGE THER
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:CAMILLE
Other - Last Name:STRECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17311 NE 175TH AVE, BUILDING C, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072
Mailing Address - Country:US
Mailing Address - Phone:425-330-3097
Mailing Address - Fax:
Practice Address - Street 1:17311 NE 175TH AVE, BUILDING C, SUITE 100
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072
Practice Address - Country:US
Practice Address - Phone:425-330-3097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0018391225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist