Provider Demographics
NPI:1083994750
Name:MYERS, AMBER NICOLE PODACH (LMP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE PODACH
Last Name:MYERS
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 1:2818 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4841
Mailing Address - Country:US
Mailing Address - Phone:206-397-3590
Mailing Address - Fax:206-922-2053
Practice Address - Street 1:2818 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4841
Practice Address - Country:US
Practice Address - Phone:206-397-3590
Practice Address - Fax:206-922-2053
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60240007225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist