Most Relevant Information
Provider Data
| NPI Number: | 1003021569 |
| Provider Name: | TIARI GARDNER DEGRAW PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/10/2007 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
1010 S 336TH ST STE 120
FEDERAL WAY
WA
980037354
Practice Location Phone/Fax
| Phone: | 8668358091 |
| Fax: | 2538357102 |
Provider Mailing Location
5802 162ND AVE E
SUMNER
WA
983903108
Provider Mailing Phone/Fax
| Phone: | 2538913108 |
| Fax: |