Provider Demographics
NPI:1881415982
Name:WASHINGTON, THERESA LYNN I
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:WASHINGTON
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41307 12TH ST W STE 105
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1454
Mailing Address - Country:US
Mailing Address - Phone:661-272-4733
Mailing Address - Fax:661-272-2857
Practice Address - Street 1:41307 12TH ST W STE 105
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1454
Practice Address - Country:US
Practice Address - Phone:661-272-4733
Practice Address - Fax:661-272-2857
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner