Provider Demographics
NPI:1366731309
Name:INGLE, MARIE PATRICIA (LMT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:PATRICIA
Last Name:INGLE
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 1:110 DEER PATH AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-2111
Mailing Address - Country:US
Mailing Address - Phone:719-671-0905
Mailing Address - Fax:
Practice Address - Street 1:110 DEER PATH AVE
Practice Address - Street 2:
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829-2111
Practice Address - Country:US
Practice Address - Phone:719-671-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9255225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist