Provider Demographics
NPI:1043440266
Name:LONGENECKER, GAIL SUZANNE (DIP LCM)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:SUZANNE
Last Name:LONGENECKER
Suffix:
Gender:F
Credentials:DIP LCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 EAGLEVIEW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504
Mailing Address - Country:US
Mailing Address - Phone:303-774-9155
Mailing Address - Fax:303-997-1811
Practice Address - Street 1:2362 EAGLEVIEW CIRCLE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504
Practice Address - Country:US
Practice Address - Phone:303-774-9155
Practice Address - Fax:303-997-1811
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3184225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist