Provider Demographics
NPI:1891085726
Name:HUBBARD, GRETCHEN RENEE' (LMT)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:RENEE'
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7782 CYNTHIA LN SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-7416
Mailing Address - Country:US
Mailing Address - Phone:360-620-5478
Mailing Address - Fax:
Practice Address - Street 1:7782 CYNTHIA LN SW
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-7416
Practice Address - Country:US
Practice Address - Phone:360-620-5478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60192784225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist