Provider Demographics
NPI:1780820654
Name:JENNINGS, TRINA G (LMP)
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:G
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14331 124TH AVE NE APT C31
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-1480
Mailing Address - Country:US
Mailing Address - Phone:425-647-8831
Mailing Address - Fax:206-420-5310
Practice Address - Street 1:11435 AVONDALE RD NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-2801
Practice Address - Country:US
Practice Address - Phone:425-647-8831
Practice Address - Fax:206-420-5310
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2011-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019642172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist