Provider Demographics
NPI:1063600716
Name:TYREE, HEATHER E (LMT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:E
Last Name:TYREE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:E
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:4816 BEAVER POND DR S
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-8768
Mailing Address - Country:US
Mailing Address - Phone:425-442-8185
Mailing Address - Fax:
Practice Address - Street 1:301 E RIO VISTA AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-2224
Practice Address - Country:US
Practice Address - Phone:360-755-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor