Provider Demographics
NPI:1013894450
Name:KEAL, WILLIAM TANNER (LMT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TANNER
Last Name:KEAL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 MAIN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-6938
Mailing Address - Country:US
Mailing Address - Phone:425-773-0058
Mailing Address - Fax:
Practice Address - Street 1:8311 212TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7443
Practice Address - Country:US
Practice Address - Phone:425-773-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60705097225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist