Provider Demographics
NPI:1285030353
Name:VERTZ, SAMI (LMT)
Entity Type:Individual
Prefix:
First Name:SAMI
Middle Name:
Last Name:VERTZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SAMI
Other - Middle Name:NICOLE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:319 SAVIO RD
Mailing Address - Street 2:
Mailing Address - City:RANDLE
Mailing Address - State:WA
Mailing Address - Zip Code:98377-9609
Mailing Address - Country:US
Mailing Address - Phone:360-953-1418
Mailing Address - Fax:
Practice Address - Street 1:101 MAIN AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98576
Practice Address - Country:US
Practice Address - Phone:360-953-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60513974225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist