Provider Demographics
NPI:1619148764
Name:GARDINER, LEANNE E (LMP)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:E
Last Name:GARDINER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 W EVERGREEN FARM WAY
Mailing Address - Street 2:#6065
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-5097
Mailing Address - Country:US
Mailing Address - Phone:360-582-9977
Mailing Address - Fax:
Practice Address - Street 1:128 D ST SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4064
Practice Address - Country:US
Practice Address - Phone:360-570-9580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0002305225700000X
WAMA00023605225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist