Provider Demographics
NPI:1174818926
Name:CULP, MARY E (LMP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CULP
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:HANOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:6973 ROAD D.3 NE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-7001
Mailing Address - Country:US
Mailing Address - Phone:509-770-1400
Mailing Address - Fax:509-770-1400
Practice Address - Street 1:835 E COLONIAL AVE STE 102
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-4617
Practice Address - Country:US
Practice Address - Phone:509-764-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60198780225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist