Provider Demographics
NPI:1275864134
Name:GEARHEART, JUDY IRENE (LMP)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:IRENE
Last Name:GEARHEART
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 1:915 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3021
Mailing Address - Country:US
Mailing Address - Phone:509-480-1254
Mailing Address - Fax:509-453-2478
Practice Address - Street 1:915 SUMMITVIEW AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3021
Practice Address - Country:US
Practice Address - Phone:509-480-1254
Practice Address - Fax:509-453-2478
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023005174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist