Provider Demographics
NPI:1477240117
Name:TEJERA PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:TEJERA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEJERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:360-701-9910
Mailing Address - Street 1:6729 187TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-8338
Mailing Address - Country:US
Mailing Address - Phone:360-701-9910
Mailing Address - Fax:
Practice Address - Street 1:6729 187TH ST SE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-8338
Practice Address - Country:US
Practice Address - Phone:360-701-9910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy