Provider Demographics
NPI:1699176040
Name:MEINECKE, ROBERT JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MEINECKE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SUMMITVIEW AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3023
Mailing Address - Country:US
Mailing Address - Phone:509-453-0300
Mailing Address - Fax:
Practice Address - Street 1:1001 SUMMITVIEW AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3023
Practice Address - Country:US
Practice Address - Phone:509-453-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60260734225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist