Provider Demographics
NPI:1376910836
Name:HASSLER, TIMOTHY (LMP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HASSLER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 19TH AVE SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4268
Mailing Address - Country:US
Mailing Address - Phone:425-338-5537
Mailing Address - Fax:844-783-6456
Practice Address - Street 1:1109 FRONTIER CIR E STE A
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-3442
Practice Address - Country:US
Practice Address - Phone:425-397-8326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60581872225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist