Provider Demographics
NPI:1366698029
Name:COLLINS, TINA MARIE (LMP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:COLLINS
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 1:9004 BRIDGEPORT WAY SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2416
Mailing Address - Country:US
Mailing Address - Phone:253-588-6343
Mailing Address - Fax:253-588-1001
Practice Address - Street 1:9004 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2416
Practice Address - Country:US
Practice Address - Phone:253-588-6343
Practice Address - Fax:253-588-1001
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60012486225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60012486OtherWASHINGTON STATE DEPARTMENT OF HEALTH