Provider Demographics
NPI:1437141124
Name:SEAGRAVE, TAMMY L (MPT)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:L
Last Name:SEAGRAVE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:THACHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 731269
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0060
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:8910 184TH AVE E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8531
Practice Address - Country:US
Practice Address - Phone:253-863-7510
Practice Address - Fax:253-863-5970
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WATH5712OtherREGENCE BS
WA130029OtherDEPT OF LABOR & INDUSTRIE
WA8935156OtherCRIME VICTIME
WA8330516Medicaid
WA8330516Medicaid
WA8935156OtherCRIME VICTIME