Provider Demographics
NPI:1104006402
Name:TRETTEVIK, TIERRA MARIE (LMP)
Entity type:Individual
Prefix:MS
First Name:TIERRA
Middle Name:MARIE
Last Name:TRETTEVIK
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 1:4290 164TH WAY SE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-9066
Mailing Address - Country:US
Mailing Address - Phone:425-643-7102
Mailing Address - Fax:
Practice Address - Street 1:14700 NE 8TH ST STE 115
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4115
Practice Address - Country:US
Practice Address - Phone:425-644-8386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024878225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist