Healthcare Provider Details

I. General information

NPI: 1912185596
Provider Name (Legal Business Name): MISS GINA K SHERBINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 S 320TH ST STE A3
FEDERAL WAY WA
98003-5620
US

IV. Provider business mailing address

2316 GARY CT
MILTON WA
98354-9390
US

V. Phone/Fax

Practice location:
  • Phone: 253-946-4524
  • Fax:
Mailing address:
  • Phone: 253-926-6886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017431
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: