Provider Demographics
NPI:1457405565
Name:BALIKIAN SHETTY, TAMAR (DPT)
Entity type:Individual
Prefix:
First Name:TAMAR
Middle Name:
Last Name:BALIKIAN SHETTY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TAMAR
Other - Middle Name:
Other - Last Name:BALIKIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9014 SE 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4704
Mailing Address - Country:US
Mailing Address - Phone:310-339-0146
Mailing Address - Fax:
Practice Address - Street 1:9014 SE 50TH ST
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-4704
Practice Address - Country:US
Practice Address - Phone:310-339-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA33344225100000X
WA61506976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist