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General NPI Number Information
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NPI Number | 1346456753
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Entity Type | Individual
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Provider Name | GINO AGOSTINELLI LMP
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Gender | Male
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12205 E 12TH AVE STE. 3
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-5461
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Country | US
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Telephone | 509-891-1400
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Fax | 509-927-0082
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Provider Business Mailing Address
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Address Line | 12205 E 12TH AVE STE. 3
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-5461
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Country | US
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Telephone | 509-891-1400
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Fax | 509-927-0082
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00006069
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License Number State | WA
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