Provider Demographics
NPI:1841978764
Name:SENGAMPHAN, TYLER TOMPKINS (DPT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:TOMPKINS
Last Name:SENGAMPHAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5507 KENWOOD PL N APT 103
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5952
Mailing Address - Country:US
Mailing Address - Phone:425-877-6045
Mailing Address - Fax:
Practice Address - Street 1:17012 AURORA AVE N STE 101
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5315
Practice Address - Country:US
Practice Address - Phone:206-788-8807
Practice Address - Fax:206-801-7780
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61420235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist