Provider Demographics
NPI:1093911109
Name:COMBS, GRETA LEANNE (LMP)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:LEANNE
Last Name:COMBS
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 1:532 5TH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337
Mailing Address - Country:US
Mailing Address - Phone:360-440-1241
Mailing Address - Fax:360-377-4111
Practice Address - Street 1:532 5TH ST
Practice Address - Street 2:STE 1
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337
Practice Address - Country:US
Practice Address - Phone:360-440-1241
Practice Address - Fax:360-377-4111
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015277225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist