Provider Demographics
NPI:1033409578
Name:LANGLEY, MARY LOU (LMP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:LANGLEY
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 1:19601 ROAD F.4 NE
Mailing Address - Street 2:
Mailing Address - City:SOAP LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98851-9701
Mailing Address - Country:US
Mailing Address - Phone:509-246-8053
Mailing Address - Fax:
Practice Address - Street 1:19601 ROAD F.4 NE
Practice Address - Street 2:
Practice Address - City:SOAP LAKE
Practice Address - State:WA
Practice Address - Zip Code:98851-9701
Practice Address - Country:US
Practice Address - Phone:509-246-8053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60214732225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 60214732OtherLICENSED MASSAGE PRACTIONER