Provider Demographics
NPI:1700099132
Name:LUNSFORD, MARY ELIZABETH (LMT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:LUNSFORD
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 1:1000 S HIGHWAY 395 PMB A121
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2663
Mailing Address - Country:US
Mailing Address - Phone:541-561-6425
Mailing Address - Fax:
Practice Address - Street 1:245 E MAIN ST
Practice Address - Street 2:SUITE D4
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1870
Practice Address - Country:US
Practice Address - Phone:541-561-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11502172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist