Provider Demographics
NPI:1093845505
Name:FITTS, GENEVRA (LMP)
Entity Type:Individual
Prefix:MS
First Name:GENEVRA
Middle Name:
Last Name:FITTS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 PLAZA WAY
Mailing Address - Street 2:#21
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4480
Mailing Address - Country:US
Mailing Address - Phone:509-526-4898
Mailing Address - Fax:
Practice Address - Street 1:120 E BIRCH ST
Practice Address - Street 2:STE. 6
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3054
Practice Address - Country:US
Practice Address - Phone:509-526-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist