Provider Demographics
NPI:1649904566
Name:DECORTE, TAMMY KAY (GCFP)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:KAY
Last Name:DECORTE
Suffix:
Gender:F
Credentials:GCFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24931 235TH WAY SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:875 140TH AVE. NE.
Practice Address - Street 2:SUITE #205
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3400
Practice Address - Country:US
Practice Address - Phone:253-951-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist