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Tyrone Lamonte Green

Massage Therapist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

622 S 320th St Unit B, Federal Way, WA 98003-5263

PECOS Enrollment

Based on the most recent information from CMS, provider Tyrone Lamonte Green does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1477052215
Provider Type
Individual
Full Name
Green, Tyrone Lamonte
Title
Mr.

Gender
Male
Sole Proprietor
No
Enumeration Date
2/7/2018
Last Updated
7/21/2022

Contact Information

Practice Location

622 S 320th St Unit B, Federal Way, WA 98003-5263

(206) 460-5004

Unlisted Fax

Mailing Location

224 S 346th Ln Apt D60, Federal Way, WA 98003-6781

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 225700000X Primary	Description Massage Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License MA60824040 Washington

Provider Identifiers

ID	Description	Issuer
ID GREENTL135BS	Description Other	Issuer DRIVERS LICENSE Washington

Tyrone Lamonte Green

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Drummond, Morgan Marie

Mcphail, Sirikit M

Vitruk, Inna

Sing, Jamey

Hill, Janese

Breese, Michelle L

Smith, Tia M

Dorbin, Alicia A

Ferrians, Ronald Damon

Young, Qwanzetta Latrese