Provider Demographics
NPI:1982833182
Name:GREENE, DEANNE (LMP)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:DEANNE
Other - Middle Name:R
Other - Last Name:CHERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:1616 BAY ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5108
Mailing Address - Country:US
Mailing Address - Phone:360-876-5119
Mailing Address - Fax:
Practice Address - Street 1:1616 BAY ST
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5108
Practice Address - Country:US
Practice Address - Phone:360-876-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013773225700000X
WA00013773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist