Provider Demographics
NPI:1134323140
Name:DELEON, IRENE G (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:G
Last Name:DELEON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 S PIONEER WAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837
Mailing Address - Country:US
Mailing Address - Phone:509-766-1211
Mailing Address - Fax:509-766-6878
Practice Address - Street 1:1418 S PIONEER WAY
Practice Address - Street 2:SUITE E
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837
Practice Address - Country:US
Practice Address - Phone:509-766-1211
Practice Address - Fax:509-766-6878
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015421225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
157584OtherPIN NUMBER