Provider Demographics
NPI:1497270904
Name:GERIENE, ANNE T (PTA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:T
Last Name:GERIENE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 SPENCER CT
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:WA
Mailing Address - Zip Code:98047
Mailing Address - Country:US
Mailing Address - Phone:253-709-1747
Mailing Address - Fax:
Practice Address - Street 1:200 ANDOVER PARK E STE 8
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2938
Practice Address - Country:US
Practice Address - Phone:206-575-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60043860225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant