Provider Demographics
NPI:1063604908
Name:MEYERS, THERESA K (LMP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:K
Last Name:MEYERS
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 1:710 S EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5654
Mailing Address - Country:US
Mailing Address - Phone:509-430-6801
Mailing Address - Fax:509-582-9578
Practice Address - Street 1:710 S EVERETT ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7159
Practice Address - Country:US
Practice Address - Phone:509-430-6801
Practice Address - Fax:509-582-9578
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023229163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0238998OtherLABOR AND INDUSTRIES