Individual
GRETCHEN DIANE TIBBETTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
123 4TH AVE NW, PUYALLUP, WA 98371-8619
(253) 848-1234
Mailing address
123 4TH AVE NW, PUYALLUP, WA 98371-8619
(253) 848-1234
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
61108477
WA
Other
Enumeration date
12/16/2022
Last updated
12/16/2022
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