Provider Demographics
NPI:1710218714
Name:MCLACHLAN, TESSA MAY (LMP)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:MAY
Last Name:MCLACHLAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 SANNA WIND WAY
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-9605
Mailing Address - Country:US
Mailing Address - Phone:360-730-2796
Mailing Address - Fax:
Practice Address - Street 1:225 ANTHES AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260
Practice Address - Country:US
Practice Address - Phone:360-221-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60002573172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist