Provider Demographics
NPI:1760487615
Name:GERMANI, MARCENE (PT)
Entity Type:Individual
Prefix:
First Name:MARCENE
Middle Name:
Last Name:GERMANI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11411 BRIDGEPORT WAY SW # WA
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3047
Mailing Address - Country:US
Mailing Address - Phone:253-589-6441
Mailing Address - Fax:253-589-4290
Practice Address - Street 1:11411 BRIDGEPORT WAY SW # WA
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3047
Practice Address - Country:US
Practice Address - Phone:253-589-6441
Practice Address - Fax:253-589-4290
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00010041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA522085558Medicare PIN