Provider Demographics
NPI:1629617808
Name:CROSSLEY, TYRA RAYANNE (LMT)
Entity Type:Individual
Prefix:
First Name:TYRA
Middle Name:RAYANNE
Last Name:CROSSLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 N STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-4670
Mailing Address - Country:US
Mailing Address - Phone:253-759-1500
Mailing Address - Fax:253-759-4172
Practice Address - Street 1:2611 N STEVENS ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-4670
Practice Address - Country:US
Practice Address - Phone:253-759-1500
Practice Address - Fax:253-759-4172
Is Sole Proprietor?:No
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61000691225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist