Provider Demographics
NPI:1053529826
Name:VINECOURT, GINA DENISE (LMP)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:DENISE
Last Name:VINECOURT
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 1:122 NE RIVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-9643
Mailing Address - Country:US
Mailing Address - Phone:360-275-7474
Mailing Address - Fax:
Practice Address - Street 1:122 NE RIVERHILL DR
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9643
Practice Address - Country:US
Practice Address - Phone:360-275-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023353225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist