Provider Demographics
NPI:1598079147
Name:MARISTUEN, THEA LYNN (PT)
Entity type:Individual
Prefix:MS
First Name:THEA
Middle Name:LYNN
Last Name:MARISTUEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8502 N NEVADA ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-7395
Mailing Address - Country:US
Mailing Address - Phone:509-487-2958
Mailing Address - Fax:
Practice Address - Street 1:8502 N NEVADA ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-7395
Practice Address - Country:US
Practice Address - Phone:509-487-2958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT601713072251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics