MEDICARE: JEANNETTE A TREMBLEY LMBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	61363200	WA

General Provider Information

NPI Number	:	1932826955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNETTE A TREMBLEY LMBT

Provider Business Mailing Address
First Line	:	8701 NE 54TH ST APT S1
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6225
Country	:	US
Telephone Number	:	704-737-4009
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 NE 54TH ST APT S1
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6225
Country	:	US
Telephone Number	:	704-737-4009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	10/20/2022

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Directions to “ JEANNETTE A TREMBLEY LMBT” Practice Location

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