Provider Demographics
NPI:1972759926
Name:SIMONS, TINA MICHELLE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MICHELLE
Last Name:SIMONS
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 1:103 SALMON BEACH
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407
Mailing Address - Country:US
Mailing Address - Phone:253-752-9448
Mailing Address - Fax:
Practice Address - Street 1:2102 N. PEARL ST.
Practice Address - Street 2:SUITE 405
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407
Practice Address - Country:US
Practice Address - Phone:253-752-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA460477138225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist