Provider Demographics
NPI:1467740480
Name:MORLAN, AMANDA J (LMP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:J
Last Name:MORLAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:128 D ST SW STE A
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4064
Mailing Address - Country:US
Mailing Address - Phone:360-570-9580
Mailing Address - Fax:360-570-9583
Practice Address - Street 1:128 D ST SW STE A
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4064
Practice Address - Country:US
Practice Address - Phone:360-570-9580
Practice Address - Fax:360-570-9583
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60050020225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist