Provider Demographics
NPI:1013151844
Name:FARUQUI-WILDMAN, TASNEEM TM
Entity Type:Individual
Prefix:MS
First Name:TASNEEM
Middle Name:TM
Last Name:FARUQUI-WILDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 WHITWORTH LN S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2413
Mailing Address - Country:US
Mailing Address - Phone:415-271-5259
Mailing Address - Fax:
Practice Address - Street 1:13028 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98168-2621
Practice Address - Country:US
Practice Address - Phone:206-244-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60069118225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist