Provider Demographics
NPI:1730324203
Name:GERSTEN, JULIET B (MA, LMP)
Entity Type:Individual
Prefix:MS
First Name:JULIET
Middle Name:B
Last Name:GERSTEN
Suffix:
Gender:F
Credentials:MA, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 992
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-0992
Mailing Address - Country:US
Mailing Address - Phone:360-221-1050
Mailing Address - Fax:
Practice Address - Street 1:919 3RD ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-9228
Practice Address - Country:US
Practice Address - Phone:360-221-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006174225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist