Provider Demographics
NPI:1336447879
Name:YARBROUGH, TESSA RENEE (LMP)
Entity Type:Individual
Prefix:MS
First Name:TESSA
Middle Name:RENEE
Last Name:YARBROUGH
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 1:5702 NE GAMBLEWOOD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9557
Mailing Address - Country:US
Mailing Address - Phone:360-710-8637
Mailing Address - Fax:
Practice Address - Street 1:3500 NW BUCKLIN HILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8503
Practice Address - Country:US
Practice Address - Phone:360-698-0836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60192666174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60192666OtherWASHINGTON STATE DEPARTMENT OF HEALTH
WA0289955556OtherAMERICAN MASSAGE THERAPY ASSOCIATION