Provider Demographics
NPI:1801124474
Name:LEWERENZ, GREGORY T (EAMP, LMP)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:T
Last Name:LEWERENZ
Suffix:
Gender:M
Credentials:EAMP, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 36TH AVE W
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-1675
Mailing Address - Country:US
Mailing Address - Phone:206-856-4096
Mailing Address - Fax:
Practice Address - Street 1:4300 36TH AVE W
Practice Address - Street 2:SUITE 130
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-1675
Practice Address - Country:US
Practice Address - Phone:206-856-4096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60114046171100000X
WAMA00023193225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist