Provider Demographics
NPI:1598087835
Name:YOUNG, GERENE BETH (LMP)
Entity Type:Individual
Prefix:
First Name:GERENE
Middle Name:BETH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W REPUBLICAN ST
Mailing Address - Street 2:#206
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4030
Mailing Address - Country:US
Mailing Address - Phone:206-612-0642
Mailing Address - Fax:
Practice Address - Street 1:411 W REPUBLICAN ST
Practice Address - Street 2:#206
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4030
Practice Address - Country:US
Practice Address - Phone:206-612-0642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018999225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist