Provider Demographics
NPI:1578844569
Name:REINAGEL, GARRETT (LMP)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:REINAGEL
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6031 54TH CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-6424
Mailing Address - Country:US
Mailing Address - Phone:360-451-0605
Mailing Address - Fax:
Practice Address - Street 1:720 SLEATER KINNEY RD SE STE 9
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1139
Practice Address - Country:US
Practice Address - Phone:360-451-0605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMASS.MA.60241021225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist