Provider Demographics
NPI:1609220607
Name:TULADHAR, PRAJNA
Entity Type:Individual
Prefix:
First Name:PRAJNA
Middle Name:
Last Name:TULADHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15513 AMBAUM BLVD SW
Mailing Address - Street 2:STE 102
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15513 AMBAUM BLVD SW
Practice Address - Street 2:STE 102
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2424
Practice Address - Country:US
Practice Address - Phone:480-272-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-16
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60532844225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist