Provider Demographics
NPI:1154874840
Name:DAMASO, TEZRA (DPT)
Entity type:Individual
Prefix:
First Name:TEZRA
Middle Name:
Last Name:DAMASO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SE PIONEER WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5705
Mailing Address - Country:US
Mailing Address - Phone:360-682-2770
Mailing Address - Fax:
Practice Address - Street 1:210 SE PIONEER WAY STE 2
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5705
Practice Address - Country:US
Practice Address - Phone:360-682-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60664733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist