Provider Demographics
NPI:1386789444
Name:COUCH, MARY ANGELA (LMT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANGELA
Last Name:COUCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4524 N STEVENSON RD
Mailing Address - Street 2:
Mailing Address - City:OTIS ORCHARDS
Mailing Address - State:WA
Mailing Address - Zip Code:99027-8708
Mailing Address - Country:US
Mailing Address - Phone:509-990-8346
Mailing Address - Fax:
Practice Address - Street 1:122 N ARGONNE RD STE 3
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2550
Practice Address - Country:US
Practice Address - Phone:509-922-2490
Practice Address - Fax:509-928-9662
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018648225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist