Individual
ANGIE TIETSORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
28 NORTH KELLER STREET, REPUBLIC, WA 99166
(336) 250-8581
(509) 775-3320
Mailing address
4466 COLT WAY, SPRINGDALE, WA 99173-5100
(336) 250-8581
(509) 775-3320
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60613576
WA
Other
Enumeration date
12/28/2015
Last updated
12/28/2015
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