Provider Demographics
NPI:1053537639
Name:SMITH, TIA M (LMP)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 SW 116TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3578
Mailing Address - Country:US
Mailing Address - Phone:206-488-3784
Mailing Address - Fax:
Practice Address - Street 1:32123 1ST AVE S
Practice Address - Street 2:SUITE A-4
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5721
Practice Address - Country:US
Practice Address - Phone:253-874-5008
Practice Address - Fax:253-874-5024
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0020390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist