Provider Demographics
NPI:1831424233
Name:GITCH, ANTHONY RAY (LMT, LMP)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:RAY
Last Name:GITCH
Suffix:
Gender:M
Credentials:LMT, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13218 NE 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-1100
Mailing Address - Country:US
Mailing Address - Phone:503-729-3102
Mailing Address - Fax:
Practice Address - Street 1:13218 NE 80TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-1100
Practice Address - Country:US
Practice Address - Phone:503-729-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15560225700000X
WAMA 60112084225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist