Provider Demographics
NPI:1811174907
Name:LANNING, MARK V (DPT)
Entity type:Individual
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First Name:MARK
Middle Name:V
Last Name:LANNING
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Gender:M
Credentials:DPT
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Mailing Address - Street 1:1188 106TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8614
Mailing Address - Country:US
Mailing Address - Phone:425-454-4864
Mailing Address - Fax:425-646-3901
Practice Address - Street 1:7525 SE 24TH ST
Practice Address - Street 2:STE 510
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2336
Practice Address - Country:US
Practice Address - Phone:206-230-8320
Practice Address - Fax:206-230-8315
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-04-25
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Provider Licenses
StateLicense IDTaxonomies
WAPT00010742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8870614Medicare PIN