Provider Demographics
NPI:1407361959
Name:AYERS, TRISHA LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:LYNN
Last Name:AYERS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:LYNN
Other - Last Name:AYERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:6408 79TH PL NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-6209
Mailing Address - Country:US
Mailing Address - Phone:425-327-7582
Mailing Address - Fax:
Practice Address - Street 1:11605 STATE AVE STE 111
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-8427
Practice Address - Country:US
Practice Address - Phone:360-657-7183
Practice Address - Fax:360-657-7188
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60534957225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist