Provider Demographics
NPI:1043870132
Name:CRANFORD, LOUANN (LMT, MMT, CLP)
Entity Type:Individual
Prefix:
First Name:LOUANN
Middle Name:
Last Name:CRANFORD
Suffix:
Gender:F
Credentials:LMT, MMT, CLP
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 177394
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75017-7394
Mailing Address - Country:US
Mailing Address - Phone:972-841-5830
Mailing Address - Fax:
Practice Address - Street 1:122 W CENTER ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3465
Practice Address - Country:US
Practice Address - Phone:972-841-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT021234225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty