Provider Demographics
NPI:1760568141
Name:GERLICH, PAMELA F (LMP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:F
Last Name:GERLICH
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 1:2101 N CASTLE WAY
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8327
Mailing Address - Country:US
Mailing Address - Phone:425-483-0647
Mailing Address - Fax:425-483-0647
Practice Address - Street 1:2101 N CASTLE WAY
Practice Address - Street 2:
Practice Address - City:BRIER
Practice Address - State:WA
Practice Address - Zip Code:98036-8327
Practice Address - Country:US
Practice Address - Phone:425-483-0647
Practice Address - Fax:425-483-0647
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013326225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0180376OtherLABOR AND INDUSTRY