Provider Demographics
NPI:1750394847
Name:DIERWECHTER, TANYA (BS, PT)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:
Last Name:DIERWECHTER
Suffix:
Gender:F
Credentials:BS, PT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:ACKERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, PT
Mailing Address - Street 1:950 PACIFIC AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4425
Mailing Address - Country:US
Mailing Address - Phone:253-383-6205
Mailing Address - Fax:
Practice Address - Street 1:950 PACIFIC AVE STE 900
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4425
Practice Address - Country:US
Practice Address - Phone:253-383-6205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00093389OtherRAILROAD MEDICARE
WA176483OtherDEPT OF LABOR & INDUSTRIE
WAA016OtherTRICARE
WA8931144OtherCRIME VICTIMS
WA3152DIOtherREGENCE BLUE SHIELD
WA8375883Medicaid
WAP00093389OtherRAILROAD MEDICARE
WA8931144OtherCRIME VICTIMS