Provider Demographics
NPI:1639734098
Name:GIRDNER, RAYNA JAY
Entity type:Individual
Prefix:
First Name:RAYNA
Middle Name:JAY
Last Name:GIRDNER
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 1:14313 NE 20TH AVE STE A114
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1485
Mailing Address - Country:US
Mailing Address - Phone:360-433-9480
Mailing Address - Fax:
Practice Address - Street 1:14313 NE 20TH AVE STE A114
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1485
Practice Address - Country:US
Practice Address - Phone:360-433-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60420427225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist