Individual
NICOLE M GLEESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
330 PIONEER AVE, MONTESANO, WA 98563
(360) 580-1667
Mailing address
103 YORK DRIVE, ABERDEEN, WA 98520
(360) 580-1667
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
MA60112062
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA60112062
WA STATE MASSAGE LICENSE NUMBER
WA
Enumeration date
02/09/2010
Last updated
04/27/2020
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