Provider Demographics
NPI:1548595622
Name:RALSTON, TAMERA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:RALSTON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6661
Mailing Address - Country:US
Mailing Address - Phone:509-947-5991
Mailing Address - Fax:
Practice Address - Street 1:7101 W HOOD PL
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6700
Practice Address - Country:US
Practice Address - Phone:509-374-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist