Provider Demographics
NPI:1528137965
Name:SHROYER, GINA LAYNE (LMT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:LAYNE
Last Name:SHROYER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20953 LAKE SIXTEEN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-7576
Mailing Address - Country:US
Mailing Address - Phone:360-391-1166
Mailing Address - Fax:
Practice Address - Street 1:20953 LAKE SIXTEEN RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-7576
Practice Address - Country:US
Practice Address - Phone:360-391-1166
Practice Address - Fax:360-445-6125
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA18310225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist