Provider Demographics
NPI:1598808685
Name:RICHARDS, TINA LOUISE (PT, OCS)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20717 6TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8359
Mailing Address - Country:US
Mailing Address - Phone:360-333-1026
Mailing Address - Fax:
Practice Address - Street 1:20717 6TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8359
Practice Address - Country:US
Practice Address - Phone:360-333-1026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA200707OtherLABOR AND INDUSTRY