Provider Demographics
NPI:1083371595
Name:STREIT, GIANNA NICOLE (LMT)
Entity Type:Individual
Prefix:
First Name:GIANNA
Middle Name:NICOLE
Last Name:STREIT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:GIANNA
Other - Middle Name:NICOLE
Other - Last Name:GROSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6973 BIRDSEYE AVE NE UNIT 408
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3508
Mailing Address - Country:US
Mailing Address - Phone:224-399-5855
Mailing Address - Fax:
Practice Address - Street 1:12001 PACIFIC AVE S STE 203
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-5101
Practice Address - Country:US
Practice Address - Phone:125-353-5667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61204947225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist