Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 60240938 | WA |
NPI | 1013251008 |
---|---|
Provider Name | Mr. Christopher Wayne Greninger |
First Address | Hoquiam, WA 98550-1067 |
Second Address | Hoquiam, WA 98550-1067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |