Provider Demographics
NPI:1831315910
Name:ALLEN, TANYA FIONA (LMT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:FIONA
Last Name:ALLEN
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:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942-0027
Mailing Address - Country:US
Mailing Address - Phone:509-697-5811
Mailing Address - Fax:
Practice Address - Street 1:604 W 4TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1673
Practice Address - Country:US
Practice Address - Phone:509-865-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014978225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0206582OtherLABOR & INDUSTRIES