Provider Demographics
NPI:1417093196
Name:EVERS, AMANDA S (LMP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:EVERS
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:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-0525
Mailing Address - Country:US
Mailing Address - Phone:360-871-5200
Mailing Address - Fax:360-871-5350
Practice Address - Street 1:4519 SE MILE HILL DR
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3909
Practice Address - Country:US
Practice Address - Phone:360-871-5200
Practice Address - Fax:360-871-5350
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014530225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-1180427-08OtherKPS
WA0169804OtherLABOR AND INDUSTRIES