Provider Demographics
NPI:1265691117
Name:LANDRY, GINGER LEE (LMP)
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:LEE
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:GINGER
Other - Middle Name:LEE
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:18463 BLUEBERRY LN
Mailing Address - Street 2:P204
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2505
Mailing Address - Country:US
Mailing Address - Phone:425-466-0383
Mailing Address - Fax:
Practice Address - Street 1:1129 W MAIN ST
Practice Address - Street 2:172
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2034
Practice Address - Country:US
Practice Address - Phone:425-466-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist