Provider Demographics
NPI:1043598451
Name:HRANAC, MARY ELIZABETH (LMP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:HRANAC
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:PO BOX 1152
Mailing Address - Street 2:5 LARSON ROAD
Mailing Address - City:MCCLEARY
Mailing Address - State:WA
Mailing Address - Zip Code:98557
Mailing Address - Country:US
Mailing Address - Phone:360-470-1219
Mailing Address - Fax:
Practice Address - Street 1:5 LARSON
Practice Address - Street 2:
Practice Address - City:MCCLEARY
Practice Address - State:WA
Practice Address - Zip Code:98557
Practice Address - Country:US
Practice Address - Phone:360-470-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60232629172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist