Provider Demographics
NPI:1952691040
Name:LANGTREE, LILLIAN PATRICIA (LMP)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:PATRICIA
Last Name:LANGTREE
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 1:328 MADISON AVE N
Mailing Address - Street 2:SUITE D
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1806
Mailing Address - Country:US
Mailing Address - Phone:206-780-2338
Mailing Address - Fax:
Practice Address - Street 1:328 MADISON AVE N
Practice Address - Street 2:SUITE D
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1806
Practice Address - Country:US
Practice Address - Phone:206-780-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0000670225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist