Provider Demographics
NPI:1851602932
Name:TOMLIN, KATHERINE LESLEY (PTA, LMP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LESLEY
Last Name:TOMLIN
Suffix:
Gender:F
Credentials:PTA, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 CEDARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1415
Mailing Address - Country:US
Mailing Address - Phone:360-733-8487
Mailing Address - Fax:
Practice Address - Street 1:1400 KING ST STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6262
Practice Address - Country:US
Practice Address - Phone:360-671-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60073700225200000X
WAMA 60118660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant