Provider Demographics
NPI:1346679933
Name:STACHES, GRETA (LMBT)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:STACHES
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 PORSHA LN
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-1469
Mailing Address - Country:US
Mailing Address - Phone:336-307-9090
Mailing Address - Fax:336-841-6984
Practice Address - Street 1:2201 EASTCHESTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-1516
Practice Address - Country:US
Practice Address - Phone:336-355-8398
Practice Address - Fax:336-841-6984
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11850225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist