Provider Demographics
NPI:1083059133
Name:HINKLE, GREGORY D (LMP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:HINKLE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 C ST SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6349
Mailing Address - Country:US
Mailing Address - Phone:360-888-9373
Mailing Address - Fax:
Practice Address - Street 1:2401 BRISTOL CT SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6003
Practice Address - Country:US
Practice Address - Phone:360-888-9268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60334887172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist