Provider Demographics
NPI:1871994079
Name:WELLER, GENASEE ROSE (LMP)
Entity type:Individual
Prefix:MRS
First Name:GENASEE
Middle Name:ROSE
Last Name:WELLER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:GENASEE
Other - Middle Name:ROSE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:124 E ROWAN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1214
Mailing Address - Country:US
Mailing Address - Phone:509-487-8000
Mailing Address - Fax:509-487-6333
Practice Address - Street 1:124 E ROWAN AVE STE 202
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1214
Practice Address - Country:US
Practice Address - Phone:509-487-8000
Practice Address - Fax:509-487-6333
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60492429225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist