Provider Demographics
NPI:1174814099
Name:HAUPT, GRETA REYNOLDS (LMP)
Entity Type:Individual
Prefix:MS
First Name:GRETA
Middle Name:REYNOLDS
Last Name:HAUPT
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 1:3715 56TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8240
Mailing Address - Country:US
Mailing Address - Phone:253-851-5138
Mailing Address - Fax:253-853-4972
Practice Address - Street 1:3715 56TH ST NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8240
Practice Address - Country:US
Practice Address - Phone:253-851-5138
Practice Address - Fax:253-853-4972
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00024499225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist