Provider Demographics
NPI:1124202452
Name:STOCK, LLOYD LEO (LMP)
Entity Type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:LEO
Last Name:STOCK
Suffix:
Gender:M
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 993
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-0993
Mailing Address - Country:US
Mailing Address - Phone:509-299-6900
Mailing Address - Fax:509-299-6900
Practice Address - Street 1:725 N STANLEY ST STE C
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-8939
Practice Address - Country:US
Practice Address - Phone:509-299-6900
Practice Address - Fax:509-299-6900
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023594225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist