Provider Demographics
NPI:1417137753
Name:BERMAN, TAMMIE WEGNER (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:WEGNER
Last Name:BERMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 244TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8359
Mailing Address - Country:US
Mailing Address - Phone:253-961-6665
Mailing Address - Fax:
Practice Address - Street 1:13954 NE 60TH WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4583
Practice Address - Country:US
Practice Address - Phone:425-890-0998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No171W00000XOther Service ProvidersContractor