Basic Information
| Provider Information | |||||||||
| NPI: | 1285939892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATARYN | ||||||||
| FirstName: | LONDA | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 WAINWRIGHT DR | ||||||||
| Address2: | HBPC 202 | ||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993623975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095255200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 77 WAINWRIGHT DR | ||||||||
| Address2: | HBPC 202 | ||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993623975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095255200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2011 | ||||||||
| LastUpdateDate: | 01/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00006339 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 3471 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.