Provider Demographics
NPI:1912185596
Name:SHERBINA, GINA K
Entity Type:Individual
Prefix:MISS
First Name:GINA
Middle Name:K
Last Name:SHERBINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 GARY CT
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9390
Mailing Address - Country:US
Mailing Address - Phone:253-926-6886
Mailing Address - Fax:
Practice Address - Street 1:2210 S 320TH ST STE A3
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5620
Practice Address - Country:US
Practice Address - Phone:253-946-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017431225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist