Provider Demographics
NPI:1386065332
Name:LUOMA, TIERRA LYNN
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:LYNN
Last Name:LUOMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4514 221ST PL SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5982
Mailing Address - Country:US
Mailing Address - Phone:425-350-7919
Mailing Address - Fax:
Practice Address - Street 1:18920 BOTHELL WAY NE #204
Practice Address - Street 2:BOTHELL INTEGRATED HEALTH LLC
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011
Practice Address - Country:US
Practice Address - Phone:425-424-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60431461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist