Provider Demographics
NPI:1649423831
Name:CASTRO, GLEBENNETTE (LMP)
Entity Type:Individual
Prefix:MS
First Name:GLEBENNETTE
Middle Name:
Last Name:CASTRO
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 1:3004 S CHARLESTOWN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-6829
Mailing Address - Country:US
Mailing Address - Phone:206-427-1162
Mailing Address - Fax:
Practice Address - Street 1:4236 36TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-1312
Practice Address - Country:US
Practice Address - Phone:206-723-2820
Practice Address - Fax:206-722-3664
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024589225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist