Provider Demographics
NPI:1770623977
Name:BERTHOLF, TRISHA (LMP)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:BERTHOLF
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 1:2310 MILDRED ST W # 130
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6036
Mailing Address - Country:US
Mailing Address - Phone:253-564-2920
Mailing Address - Fax:253-564-0135
Practice Address - Street 1:5775 SOUNDVIEW DR
Practice Address - Street 2:STE# 101C
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2211
Practice Address - Country:US
Practice Address - Phone:253-564-2920
Practice Address - Fax:253-514-8110
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010739225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5197BEOtherREGENCE
WA224140OtherL & I