Provider Demographics
NPI:1821366626
Name:BARNES, TYLER D (LMP)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:D
Last Name:BARNES
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2853
Mailing Address - Country:US
Mailing Address - Phone:509-326-3795
Mailing Address - Fax:509-464-0392
Practice Address - Street 1:3809 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2853
Practice Address - Country:US
Practice Address - Phone:509-326-3795
Practice Address - Fax:509-464-0392
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60259540225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60259540OtherSTATE LICENSE