Provider Demographics
NPI:1417088048
Name:THOMPSON, TARA SUNSHINE (LMT)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:SUNSHINE
Last Name:THOMPSON
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 1:1001 S 41ST AVE # 7
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3843
Mailing Address - Country:US
Mailing Address - Phone:509-307-6961
Mailing Address - Fax:509-972-4001
Practice Address - Street 1:1008 S 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3804
Practice Address - Country:US
Practice Address - Phone:509-972-4000
Practice Address - Fax:509-972-4001
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015454174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00015454OtherMASSAGE PRACTITIONER