Provider Demographics
NPI:1417254889
Name:BARNES, AIMEE LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:LYNN
Last Name:BARNES
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 1:640 19TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-1522
Mailing Address - Country:US
Mailing Address - Phone:503-421-7691
Mailing Address - Fax:
Practice Address - Street 1:4475 SW SCHOLLS FERRY RD
Practice Address - Street 2:201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1955
Practice Address - Country:US
Practice Address - Phone:503-421-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13115225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist