Provider Demographics
NPI:1649433897
Name:GRECO, SHELIE
Entity type:Individual
Prefix:
First Name:SHELIE
Middle Name:
Last Name:GRECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 WESTBOURNE LOOP
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:WA
Mailing Address - Zip Code:99323-8517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:386 WESTBOURNE LOOP
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:WA
Practice Address - Zip Code:99323-8517
Practice Address - Country:US
Practice Address - Phone:509-378-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60021377225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist