Provider Demographics
NPI:1225494297
Name:CHRISTENSON-DILLON, TISHA (LMP)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:CHRISTENSON-DILLON
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 1:1778 WATSON ST N
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3447
Mailing Address - Country:US
Mailing Address - Phone:360-609-6653
Mailing Address - Fax:360-802-0731
Practice Address - Street 1:1778 WATSON ST N
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3447
Practice Address - Country:US
Practice Address - Phone:360-609-6653
Practice Address - Fax:360-802-0731
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009931225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist