Provider Demographics
NPI:1902155609
Name:TAGLIABUE, TERA (DPT)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:
Last Name:TAGLIABUE
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 1:18404 102ND AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3380
Mailing Address - Country:US
Mailing Address - Phone:425-486-6079
Mailing Address - Fax:
Practice Address - Street 1:18404 102ND AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3380
Practice Address - Country:US
Practice Address - Phone:425-486-6079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60280480225100000X
WAMA 00019510225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist