Provider Demographics
NPI:1053485656
Name:POLETTI, GLENDA SUE (LMP)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:SUE
Last Name:POLETTI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:GLENDA
Other - Middle Name:SUE
Other - Last Name:LALIBERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:2400 NW 80TH ST
Mailing Address - Street 2:#120
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4449
Mailing Address - Country:US
Mailing Address - Phone:206-632-8300
Mailing Address - Fax:206-632-8301
Practice Address - Street 1:10021 HOLMAN RD NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98177-4920
Practice Address - Country:US
Practice Address - Phone:206-632-8300
Practice Address - Fax:206-632-8301
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012824225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist