Provider Demographics
NPI:1508602772
Name:MAISON, TERESA (PTA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MAISON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S 72ND AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-1689
Mailing Address - Country:US
Mailing Address - Phone:509-453-3103
Mailing Address - Fax:
Practice Address - Street 1:210 S 72ND AVE STE 130
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1689
Practice Address - Country:US
Practice Address - Phone:509-453-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60042706225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant