Provider Demographics
NPI:1174171128
Name:REINKE, ELIZABETH DEE (LMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DEE
Last Name:REINKE
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 1:915 PIONEER ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-9323
Mailing Address - Country:US
Mailing Address - Phone:701-540-1559
Mailing Address - Fax:
Practice Address - Street 1:8221 NE HAZEL DELL AVE STE 103
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8153
Practice Address - Country:US
Practice Address - Phone:701-540-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60957758225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist