Provider Demographics
NPI:1992924377
Name:GENDREAU, AIMEE ALBERTA (LMP)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:ALBERTA
Last Name:GENDREAU
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 1:13880 38TH AVE S
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4021
Mailing Address - Country:US
Mailing Address - Phone:206-257-9176
Mailing Address - Fax:
Practice Address - Street 1:22312 MARINE VIEW DR S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6832
Practice Address - Country:US
Practice Address - Phone:206-824-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019367172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist