Provider Demographics
NPI:1124466370
Name:BELSITO, TABATHA (LMP)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:
Last Name:BELSITO
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 1:8904 W TUCANNON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7178
Mailing Address - Country:US
Mailing Address - Phone:509-783-8145
Mailing Address - Fax:509-783-8147
Practice Address - Street 1:8904 W TUCANNON AVE STE B
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7178
Practice Address - Country:US
Practice Address - Phone:509-783-8145
Practice Address - Fax:509-783-8147
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60359791225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60359791OtherSTATE CREDENTIAL