Provider Demographics
NPI:1437510732
Name:TUCKER, AMY ELAINE (LMP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELAINE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELAINE
Other - Last Name:AMONETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:1900 W NICKERSON ST
Mailing Address - Street 2:SUITE 116-31
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-1661
Mailing Address - Country:US
Mailing Address - Phone:661-331-0470
Mailing Address - Fax:
Practice Address - Street 1:661 W NICKERSON ST
Practice Address - Street 2:#3
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-1540
Practice Address - Country:US
Practice Address - Phone:661-331-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60635494225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist