Healthcare Provider Details

I. General information

NPI: 1659453215
Provider Name (Legal Business Name): SHERYLL LYNNE GREGORY LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/29/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 VINE MAPLE LN
FREELAND WA
98249
US

IV. Provider business mailing address

3320 W MCGRAW ST #4
SEATTLE WA
98199
US

V. Phone/Fax

Practice location:
  • Phone: 206-789-4511
  • Fax:
Mailing address:
  • Phone: 206-283-9910
  • Fax: 206-283-9935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00005106
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: