Provider Demographics
NPI:1982723029
Name:WALMER, ELENA (LMT)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:WALMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 LENORE DR
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-1932
Mailing Address - Country:US
Mailing Address - Phone:253-756-6834
Mailing Address - Fax:
Practice Address - Street 1:4103 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE C
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4300
Practice Address - Country:US
Practice Address - Phone:253-460-1824
Practice Address - Fax:253-460-1920
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0135797OtherL&I