Provider Demographics
NPI:1215905278
Name:DEROCHE, TAMMY (DPT)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:
Last Name:DEROCHE
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 1:6520 226TH PL SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8969
Mailing Address - Country:US
Mailing Address - Phone:425-392-8611
Mailing Address - Fax:425-392-9012
Practice Address - Street 1:6520 226TH PL SE
Practice Address - Street 2:SUITE 205
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8969
Practice Address - Country:US
Practice Address - Phone:425-392-8611
Practice Address - Fax:425-392-9012
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009705225100000X
IL70010260225100000X
COPTL-6970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8422792Medicaid
WA7111645OtherAETNA
WA196053OtherDEPT OF LABOR & INDUSTRY
WA8906265OtherCRIME VICTIMS
WA4295DEOtherREGENCE BLUE SHIELD
WA7111645OtherAETNA
WA8906265OtherCRIME VICTIMS