Provider Demographics
NPI:1962794180
Name:PELLETIER, TRINA JOY (LMP)
Entity type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:JOY
Last Name:PELLETIER
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 1:111 W NORTH RIVER DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3204
Mailing Address - Country:US
Mailing Address - Phone:509-315-8758
Mailing Address - Fax:509-315-8944
Practice Address - Street 1:111 W NORTH RIVER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3204
Practice Address - Country:US
Practice Address - Phone:509-315-8758
Practice Address - Fax:509-315-8944
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60222483225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist