Provider Demographics
NPI:1982810396
Name:HARP, TIMOTHY CARL (LMP, CR)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CARL
Last Name:HARP
Suffix:
Gender:M
Credentials:LMP, CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16314 NE 82ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-1531
Mailing Address - Country:US
Mailing Address - Phone:360-256-3899
Mailing Address - Fax:
Practice Address - Street 1:6307 NE 117TH AVE STE C
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-5500
Practice Address - Country:US
Practice Address - Phone:360-253-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012668225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist