Provider Demographics
NPI:1598043598
Name:KERCHEVAL, TYNIA AMON (PTA)
Entity Type:Individual
Prefix:
First Name:TYNIA
Middle Name:AMON
Last Name:KERCHEVAL
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 1:16104 123RD AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9658
Mailing Address - Country:US
Mailing Address - Phone:206-293-1422
Mailing Address - Fax:
Practice Address - Street 1:491 S 338TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6290
Practice Address - Country:US
Practice Address - Phone:253-661-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60031531225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant