Provider Demographics
NPI:1326563750
Name:THOMASSON, AMBUR ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:AMBUR
Middle Name:ELIZABETH
Last Name:THOMASSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13221 106TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-3016
Mailing Address - Country:US
Mailing Address - Phone:805-798-4126
Mailing Address - Fax:
Practice Address - Street 1:13221 106TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-3016
Practice Address - Country:US
Practice Address - Phone:805-798-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60716142225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47534OtherCALIFORNIA MASSAGE THERAPY COUNCIL
WA60716142OtherWASHINGTON STATE DEPARTMENT OF HEALTH