Provider Demographics
NPI:1104130913
Name:CAREY, TYLER JAMES (LMP)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:CAREY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 NE 79TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4465
Mailing Address - Country:US
Mailing Address - Phone:425-861-3832
Mailing Address - Fax:425-861-3808
Practice Address - Street 1:16700 NE 79TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4465
Practice Address - Country:US
Practice Address - Phone:425-861-3832
Practice Address - Fax:425-861-3808
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60159900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist