Provider Demographics
NPI:1447564653
Name:FURLONG, ANNALIESE (CP)
Entity Type:Individual
Prefix:
First Name:ANNALIESE
Middle Name:
Last Name:FURLONG
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N CHRISMAN RD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-9314
Mailing Address - Country:US
Mailing Address - Phone:509-371-9661
Mailing Address - Fax:509-371-9662
Practice Address - Street 1:969 STEVENS DR STE 2B
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3558
Practice Address - Country:US
Practice Address - Phone:509-371-9661
Practice Address - Fax:509-371-9662
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter