Provider Demographics
NPI:1437374246
Name:MANFORD, SAMANTHA K (LMP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:K
Last Name:MANFORD
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 1:802 S G ST
Mailing Address - Street 2:APT B
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4630
Mailing Address - Country:US
Mailing Address - Phone:253-970-0835
Mailing Address - Fax:
Practice Address - Street 1:33427 PACIFIC HWY S
Practice Address - Street 2:C-1
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6897
Practice Address - Country:US
Practice Address - Phone:253-874-2498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023631225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00023631OtherMASSAGE PRACTITIONER