Provider Demographics
NPI:1902288715
Name:SHASH, TOMAS (LMP BS-BIO)
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:
Last Name:SHASH
Suffix:
Gender:M
Credentials:LMP BS-BIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 BRIDGEPORT WAY W
Mailing Address - Street 2:STE. B
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4325
Mailing Address - Country:US
Mailing Address - Phone:253-564-5828
Mailing Address - Fax:253-564-0115
Practice Address - Street 1:4113 BRIDGEPORT WAY W
Practice Address - Street 2:STE. B
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4325
Practice Address - Country:US
Practice Address - Phone:253-564-5828
Practice Address - Fax:253-564-0115
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60566787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist