Provider Demographics
NPI:1023526597
Name:LEPESKA, TINA (LMT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:LEPESKA
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 1:13416 BOTHELL EVERETT HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5311
Mailing Address - Country:US
Mailing Address - Phone:425-382-1819
Mailing Address - Fax:
Practice Address - Street 1:13416 BOTHELL EVERETT HWY STE 201
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-5311
Practice Address - Country:US
Practice Address - Phone:425-382-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60178056225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist