Provider Demographics
NPI:1134459985
Name:TROUT, AMANDA (LMP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TROUT
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 1:17651 1ST AVE S
Mailing Address - Street 2:STE 101
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2715
Mailing Address - Country:US
Mailing Address - Phone:206-241-3836
Mailing Address - Fax:206-241-3967
Practice Address - Street 1:17651 1ST AVE S
Practice Address - Street 2:STE 101
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2715
Practice Address - Country:US
Practice Address - Phone:206-241-3836
Practice Address - Fax:206-241-3967
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60093463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist