Provider Demographics
NPI:1003019753
Name:MANLEY, TERI L (LAC)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:L
Last Name:MANLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14090 FRYELANDS BLVD SE STE 306
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2693
Mailing Address - Country:US
Mailing Address - Phone:206-384-8736
Mailing Address - Fax:
Practice Address - Street 1:14090 FRYELANDS BLVD SE STE 306
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2693
Practice Address - Country:US
Practice Address - Phone:206-384-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002404171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist