Provider Demographics
NPI:1497964282
Name:BURTON, AMY L (LMP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BURTON
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 1:7604 NE 5TH AVE
Mailing Address - Street 2:#109
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8200
Mailing Address - Country:US
Mailing Address - Phone:360-314-4380
Mailing Address - Fax:
Practice Address - Street 1:7604 NE 5TH AVE
Practice Address - Street 2:#109
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8200
Practice Address - Country:US
Practice Address - Phone:360-314-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015923225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist