Provider Demographics
NPI:1174271365
Name:SYTH, AMANDA M
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:SYTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 ROAD N NE
Mailing Address - Street 2:
Mailing Address - City:COULEE CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99115-9537
Mailing Address - Country:US
Mailing Address - Phone:509-398-1974
Mailing Address - Fax:
Practice Address - Street 1:124 E 3RD AVE STE 201
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-5935
Practice Address - Country:US
Practice Address - Phone:509-398-1974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist