Provider Demographics
NPI:1235683103
Name:GICHERO, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:GICHERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S 272ND ST APT C35
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-7970
Mailing Address - Country:US
Mailing Address - Phone:913-526-0712
Mailing Address - Fax:
Practice Address - Street 1:4001 CAPITAL MALL DR SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8657
Practice Address - Country:US
Practice Address - Phone:360-754-9792
Practice Address - Fax:360-754-2455
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60658607225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant