Provider Demographics
NPI:1760860845
Name:ADAIR, TINA GAIL (LMP)
Entity type:Individual
Prefix:MISS
First Name:TINA
Middle Name:GAIL
Last Name:ADAIR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 N EDISON ST
Mailing Address - Street 2:APT C 102
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-4954
Mailing Address - Country:US
Mailing Address - Phone:509-440-7200
Mailing Address - Fax:
Practice Address - Street 1:530 N EDISON ST
Practice Address - Street 2:APT C 102
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-4954
Practice Address - Country:US
Practice Address - Phone:509-440-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60485016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist