Provider Demographics
NPI:1558309997
Name:HUNTLEY, GINA DEVER (LMT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:DEVER
Last Name:HUNTLEY
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 1:28740 SW PARKWAY AVENUE
Mailing Address - Street 2:#A4
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070
Mailing Address - Country:US
Mailing Address - Phone:503-329-6365
Mailing Address - Fax:
Practice Address - Street 1:28740 SW PARKWAY AVENUE
Practice Address - Street 2:#A4
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070
Practice Address - Country:US
Practice Address - Phone:503-329-6365
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10942225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist