Provider Demographics
NPI:1346134012
Name:WANG, TIMOTHY (LMT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WANG
Suffix:
Gender:X
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 SE BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1612
Mailing Address - Country:US
Mailing Address - Phone:425-516-4727
Mailing Address - Fax:
Practice Address - Street 1:2330 EASTGATE ST STE 205
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1559
Practice Address - Country:US
Practice Address - Phone:425-516-4727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61590681225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist