1063551869 NPI number — MISS LORI LYNN GHERMAN LMP LICENSED MASSAGE

Table of content: MISS LORI LYNN GHERMAN LMP LICENSED MASSAGE (NPI 1063551869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063551869 NPI number — MISS LORI LYNN GHERMAN LMP LICENSED MASSAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHERMAN
Provider First Name:
LORI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LMP LICENSED MASSAGE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063551869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 222
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZILLAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-969-0927
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 SO 4TH ST
Provider Second Line Business Practice Location Address:
YAKIMA VALLEY CHIROPRACTIC CENTER
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-2600
Provider Business Practice Location Address Fax Number:
509-837-2291
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA00022900 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 216034 . This is a "L AND I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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