Provider Demographics
NPI:1881010254
Name:LANNING, MARY ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:LANNING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ELI
Other - Middle Name:
Other - Last Name:LANNING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3818 SE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3815
Mailing Address - Country:US
Mailing Address - Phone:503-329-1130
Mailing Address - Fax:
Practice Address - Street 1:3818 SE 13TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3815
Practice Address - Country:US
Practice Address - Phone:503-329-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18241225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist