Provider Demographics
NPI:1417715715
Name:CRIDDLE, TARA (LMT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CRIDDLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:BRANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23403 E MISSION AVE STE 231
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-5087
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23403 E MISSION AVE STE 231
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5087
Practice Address - Country:US
Practice Address - Phone:509-367-4209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist