Provider Demographics
NPI:1104203876
Name:BARBER, AMANDA JANAY (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANAY
Last Name:BARBER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 NE 61ST ST
Mailing Address - Street 2:#100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8753
Mailing Address - Country:US
Mailing Address - Phone:503-974-6463
Mailing Address - Fax:
Practice Address - Street 1:717 NE 61ST ST
Practice Address - Street 2:#100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8753
Practice Address - Country:US
Practice Address - Phone:503-974-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60263717172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker