Provider Demographics
NPI:1356002943
Name:GEISERT, IRENE RENEE-PAGEL (LMT)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:RENEE-PAGEL
Last Name:GEISERT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4837 S SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-3510
Mailing Address - Country:US
Mailing Address - Phone:206-860-2669
Mailing Address - Fax:
Practice Address - Street 1:1119 PACIFIC AVE STE 1309
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4323
Practice Address - Country:US
Practice Address - Phone:206-860-2669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009784225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist