Provider Demographics
NPI:1437387917
Name:HUDDLE, MARY V (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:V
Last Name:HUDDLE
Suffix:
Gender:F
Credentials:LMT
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 235
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:KY
Mailing Address - Zip Code:41531-0235
Mailing Address - Country:US
Mailing Address - Phone:606-353-6712
Mailing Address - Fax:606-353-6712
Practice Address - Street 1:2047 ST HWY 319
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:KY
Practice Address - Zip Code:41531-8711
Practice Address - Country:US
Practice Address - Phone:606-353-6712
Practice Address - Fax:606-353-6712
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3435225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist