Provider Demographics
NPI:1649764523
Name:KOLITO, TONYA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIE
Last Name:KOLITO
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 1:611 NE LARSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-9270
Mailing Address - Country:US
Mailing Address - Phone:904-923-7700
Mailing Address - Fax:
Practice Address - Street 1:611 NE LARSON BLVD
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9270
Practice Address - Country:US
Practice Address - Phone:904-923-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60857281225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60857281OtherDEPARTMENT OF HEALTH