Provider Demographics
NPI:1932491198
Name:NEACE, ATINA MARRIE (LMP)
Entity Type:Individual
Prefix:
First Name:ATINA
Middle Name:MARRIE
Last Name:NEACE
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 1:65505 NE PR SOLAR RD
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320
Mailing Address - Country:US
Mailing Address - Phone:509-737-7283
Mailing Address - Fax:
Practice Address - Street 1:300 TORBETT ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2604
Practice Address - Country:US
Practice Address - Phone:509-737-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist