Provider Demographics
NPI:1326214016
Name:UDLAND, CHRISTINE RACHEL (LMP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RACHEL
Last Name:UDLAND
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 1:7513 147TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-8003
Mailing Address - Country:US
Mailing Address - Phone:253-355-2312
Mailing Address - Fax:253-396-1012
Practice Address - Street 1:7513 147TH STREET CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-8003
Practice Address - Country:US
Practice Address - Phone:253-355-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025351225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist