Provider Demographics
NPI:1790917458
Name:GIRDNER, GENEVIEVE Y (ATC)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:Y
Last Name:GIRDNER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 TALON LN E
Mailing Address - Street 2:SUITE C
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-6608
Mailing Address - Country:US
Mailing Address - Phone:360-456-1210
Mailing Address - Fax:360-459-9954
Practice Address - Street 1:2755 MOTTMAN RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-5684
Practice Address - Country:US
Practice Address - Phone:360-352-5077
Practice Address - Fax:360-352-5022
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA16000714472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2000000087OtherBOARD OF CERTIFICATION, INC.
WAA1600071447OtherSTATE LICENSE