Provider Demographics
NPI:1093040909
Name:AMBURGY, MISTY (MASSAGE PRACTICIONER)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:AMBURGY
Suffix:
Gender:F
Credentials:MASSAGE PRACTICIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 POINT BROWN AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEAN SHORES
Mailing Address - State:WA
Mailing Address - Zip Code:98569-9726
Mailing Address - Country:US
Mailing Address - Phone:360-289-4277
Mailing Address - Fax:
Practice Address - Street 1:548 POINT BROWN AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:OCEAN SHORES
Practice Address - State:WA
Practice Address - Zip Code:98569
Practice Address - Country:US
Practice Address - Phone:360-289-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024914225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist