Provider Demographics
NPI:1760798243
Name:TERAO, MAURISA MUN GIT CHIEMI (DPT)
Entity Type:Individual
Prefix:
First Name:MAURISA
Middle Name:MUN GIT CHIEMI
Last Name:TERAO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 N PEARL ST STE 203
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2550
Mailing Address - Country:US
Mailing Address - Phone:253-756-7878
Mailing Address - Fax:253-756-9634
Practice Address - Street 1:2102 N PEARL ST STE 203
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2550
Practice Address - Country:US
Practice Address - Phone:253-756-7878
Practice Address - Fax:253-756-9634
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA500008676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7075484Medicaid
WAGAB20626Medicare PIN